The Evolution of Modern Medicine

William Osler

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The Evolution of Modern Medicine

by William Osler

December, 1998 [Etext #1566]

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THE EVOLUTION OF MODERN MEDICINE

A SERIES OF LECTURES DELIVEREDAT YALE UNIVERSITY ON THE SILLIMANFOUNDATION IN APRIL, 1913

by WILLIAM OSLER

THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left tothe President and Fellows of Yale College in the city of NewHaven, to be held in trust, as a gift from her children, inmemory of their beloved and honored mother, Mrs. Hepsa ElySilliman.

On this foundation Yale College was requested and directed toestablish an annual course of lectures designed to illustrate thepresence and providence, the wisdom and goodness of God, asmanifested in the natural and moral world. These were to bedesignated as the Mrs. Hepsa Ely Silliman Memorial Lectures. Itwas the belief of the testator that any orderly presentation ofthe facts of nature or history contributed to the end of thisfoundation more effectively than any attempt to emphasize theelements of doctrine or of creed; and he therefore provided thatlectures on dogmatic or polemical theology should be excludedfrom the scope of this foundation, and that the subjects shouldbe selected rather from the domains of natural science andhistory, giving special prominence to astronomy, chemistry,geology and anatomy.

It was further directed that each annual course should be madethe basis of a volume to form part of a series constituting amemorial to Mrs. Silliman. The memorial fund came into thepossession of the Corporation of Yale University in the year1901; and the present volume constitutes the tenth of the seriesof memorial lectures.

CONTENTSChapter II. Greek MedicineChapter III. Mediaeval MedicineChapter IV. The Renaissance and the Rise of Anatomy andPhysiologyChapter V. The Rise and Development of Modern MedicineChapter VI. The Rise of Preventive Medicine

PREFACE

THE manuscript of Sir William Osler's lectures on the "Evolutionof Modern Medicine," delivered at Yale University in April, 1913,on the Silliman Foundation, was immediately turned in to the YaleUniversity Press for publication. Duly set in type, proofs ingalley form had been submitted to him and despite countlessinterruptions he had already corrected and revised a number ofthe galleys when the great war came. But with the war on, hethrew himself with energy and devotion into the military andpublic duties which devolved upon him and so never completed his

proof-reading and intended alterations. The careful correctionswhich Sir William made in the earlier galleys show that thelectures were dictated, in the first instance, as loose memorandafor oral delivery rather than as finished compositions for theeye, while maintaining throughout the logical continuity and theengaging con moto which were so characteristic of his literarystyle. In revising the lectures for publication, therefore, theeditors have merely endeavored to carry out, with care andbefitting reverence, the indications supplied in the earliergalleys by Sir William himself. In supplying dates and referenceswhich were lacking, his preferences as to editions and readingshave been borne in mind. The slight alterations made, theadaptation of the text to the eye, detract nothing from theoriginal freshness of the work.

In a letter to one of the editors, Osler described these lecturesas "an aeroplane flight over the progress of medicine through theages." They are, in effect, a sweeping panoramic survey of thewhole vast field, covering wide areas at a rapid pace, yet withan extraordinary variety of detail. The slow, painful characterof the evolution of medicine from the fearsome, superstitiousmental complex of primitive man, with his amulets, healing godsand disease demons, to the ideal of a clear-eyed rationalism istraced with faith and a serene sense of continuity. The authorsaw clearly and felt deeply that the men who have made an idea ordiscovery viable and valuable to humanity are the deserving men;he has made the great names shine out, without any depreciationof the important work of lesser men and without cluttering up hisnarrative with the tedious prehistory of great discoveries orwith shrill claims to priority. Of his skill in differentiatingthe sundry "strains" of medicine, there is specific witness ineach section. Osler's wide culture and control of the bestavailable literature of his subject permitted him to range theampler aether of Greek medicine or the earth-fettered schools oftoday with equal mastery; there is no quickset of pedantrybetween the author and the reader. The illustrations (which hehad doubtless planned as fully for the last as for the earlierchapters) are as he left them; save that, lacking legends, thesehave been supplied and a few which could not be identified havewith regret been omitted. The original galley proofs have beenrevised and corrected from different viewpoints by Fielding H.Garrison, Harvey Cushing, Edward C. Streeter and latterly byLeonard L. Mackall (Savannah, Ga.), whose zeal and persistence inthe painstaking verification of citations and references cannotbe too highly commended.

In the present revision, a number of important corrections, mostof them based upon the original MS., have been made by Dr. W.W.Francis (Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter,Mr. L.L. Mackall and others.

This work, composed originally for a lay audience and for popularconsumption, will be to the aspiring medical student and thehardworking practitioner a lift into the blue, an inspiring vistaor "Pisgah-sight" of the evolution of medicine, a realization ofwhat devotion, perseverance, valor and ability on the part ofphysicians have contributed to this progress, and of the

creditable part which our profession has played in the generaldevelopment of science.

The editors have no hesitation in presenting these lectures tothe profession and to the reading public as one of the mostcharacteristic productions of the best-balanced, best-equipped,most sagacious and most lovable of all modern physicians.

F.H.G.

BUT on that account, I say, we ought not to reject the ancientArt, as if it were not, and had not been properly founded,because it did not attain accuracy in all things, but rather,since it is capable of reaching to the greatest exactitude byreasoning, to receive it and admire its discoveries, made from astate of great ignorance, and as having been well and properlymade, and not from chance. (Hippocrates, On Ancient Medicine,Adams edition, Vol. 1, 1849, p. 168.)

THE true and lawful goal of the sciences is none other than this:that human life be endowed with new discoveries and powers.(Francis Bacon, Novum Organum, Aphorisms, LXXXI, Spedding'stranslation.)

A GOLDEN thread has run throughout the history of the world,consecutive and continuous, the work of the best men insuccessive ages. From point to point it still runs, and when nearyou feel it as the clear and bright and searchingly irresistiblelight which Truth throws forth when great minds conceive it.(Walter Moxon, Pilocereus Senilis and Other Papers, 1887, p. 4.)

FOR the mind depends so much on the temperament and dispositionof the bodily organs that, if it is possible to find a means ofrendering men wiser and cleverer than they have hitherto been, Ibelieve that it is in medicine that it must be sought. It is truethat the medicine which is now in vogue contains little of whichthe utility is remarkable; but, without having any intention ofdecrying it, I am sure that there is no one, even among those whomake its study a profession, who does not confess that all thatmen know is almost nothing in comparison with what remains to beknown; and that we could be free of an infinitude of maladiesboth of body and mind, and even also possibly of the infirmitiesof age, if we had sufficient knowledge of their causes, and ofall the remedies with which nature has provided us. (Descartes:Discourse on the Method, Philosophical Works. Translated by E.S. Haldane and G. R. T. Ross. Vol. I, Cam. Univ. Press, 1911, p.120.)

CHAPTER I

INTRODUCTION

SAIL to the Pacific with some Ancient Mariner, and traverse dayby day that silent sea until you reach a region never beforefurrowed by keel where a tiny island, a mere speck on the vastocean, has just risen from the depths, a little coral reef cappedwith green, an atoll, a mimic earth, fringed with life, built upthrough countless ages by life on the remains of life that haspassed away. And now, with wings of fancy, join Ianthe in themagic car of Shelley, pass the eternal gates of the flamingramparts of the world and see his vision:

Below lay stretched the boundless Universe!There, far as the remotest lineThat limits swift imagination's flight,Unending orbs mingled in mazy motion, Immutably fulfilling Eternal Nature's law. Above, below, around, The circling systems formed A wilderness of harmony.(Daemon of the World, Pt. I.)

And somewhere, "as fast and far the chariot flew," amid themighty globes would be seen a tiny speck, "earth's distant orb,"one of "the smallest lights that twinkle in the heavens."Alighting, Ianthe would find something she had probably not seenelsewhere in her magic flight--life, everywhere encircling thesphere. And as the little coral reef out of a vast depth had beenbuilt up by generations of polyzoa, so she would see that on theearth, through illimitable ages, successive generations ofanimals and plants had left in stone their imperishable records:and at the top of the series she would meet the thinking,breathing creature known as man. Infinitely little as is thearchitect of the atoll in proportion to the earth on which itrests, the polyzoon, I doubt not, is much larger relatively thanis man in proportion to the vast systems of the Universe, inwhich he represents an ultra-microscopic atom less ten thousandtimes than the tiniest of the "gay motes that people thesunbeams." Yet, with colossal audacity, this thinking atomregards himself as the anthropocentric pivot around which revolvethe eternal purposes of the Universe. Knowing not whence hecame, why he is here, or whither he is going, man feels himselfof supreme importance, and certainly is of interest--to himself.Let us hope that he has indeed a potency and importance out ofall proportion to his somatic insignificance. We know of toxinsof such strength that an amount too infinitesimal to be gaugedmay kill; and we know that "the unit adopted in certainscientific work is the amount of emanation produced by onemillion-millionth of a grain of radium, a quantity which itselfhas a volume of less than a million-millionth of a cubicmillimetre and weighs a million million times less than anexceptionally delicate chemical balance will turn to" (Soddy,1912). May not man be the radium of the Universe? At any ratelet us not worry about his size. For us he is a very potentcreature, full of interest, whose mundane story we are only

beginning to unravel.

Civilization is but a filmy fringe on the history of man. Go backas far as his records carry us and the story written on stone isof yesterday in comparison with the vast epochs of time whichmodern studies demand for his life on the earth. For two millions(some hold even three millions) of years man lived and moved andhad his being in a world very different from that upon which welook out. There appear, indeed, to have been various types ofman, some as different from us as we are from the anthropoidapes. What upstarts of yesterday are the Pharaohs in comparisonwith the men who survived the tragedy of the glacial period! Theancient history of man--only now beginning to be studied-- datesfrom the Pliocene or Miocene period; the modern history, as weknow it, embraces that brief space of time that has elapsed sincethe earliest Egyptian and Babylonian records were made. This hasto be borne in mind in connection with the present mental statusof man, particularly in his outlook upon nature. In his thoughtsand in his attributes, mankind at large is controlled byinherited beliefs and impulses, which countless thousands ofyears have ingrained like instinct. Over vast regions of theearth today, magic, amulets, charms, incantations are the chiefweapons of defense against a malignant nature; and in disease,the practice of Asa[*] is comparatively novel and unusual; indays of illness many millions more still seek their gods ratherthan the physicians. In an upward path man has had to work outfor himself a relationship with his fellows and with nature. Hesought in the supernatural an explanation of the pressingphenomena of life, peopling the world with spiritual beings,deifying objects of nature, and assigning to them benign ormalign influences, which might be invoked or propitiated.Primitive priest, physician and philosopher were one, andstruggled, on the one hand, for the recognition of certainpractices forced on him by experience, and on the other, for therecognition of mystical agencies which control the dark,"uncharted region" about him--to use Prof. Gilbert Murray'sphrase-- and were responsible for everything he could notunderstand, and particularly for the mysteries of disease. Plinyremarks that physic "was early fathered upon the gods"; and tothe ordinary non-medical mind, there is still somethingmysterious about sickness, something outside the ordinarystandard.

[*] II Chronicles xvi, 12.

Modern anthropologists claim that both religion and medicine tookorigin in magic, "that spiritual protoplasm," as Miss JaneHarrison calls it. To primitive man, magic was the setting inmotion of a spiritual power to help or to hurt the individual,and early forms may still be studied in the native races. Thispower, or "mana," as it is called, while possessed in a certaindegree by all, may be increased by practice. Certain individualscome to possess it very strongly: among native Australians todayit is still deliberately cultivated. Magic in healing seeks tocontrol the demons, or forces; causing disease; and in a way itmay be thus regarded as a "lineal ancestor of modern science"

(Whetham), which, too, seeks to control certain forces, nolonger, however, regarded as supernatural.

Primitive man recognized many of these superhuman agenciesrelating to disease, such as the spirits of the dead, eitherhuman or animal, independent disease demons, or individuals whomight act by controlling the spirits or agencies of disease. Wesee this today among the negroes of the Southern States. AHoodoo put upon a negro may, if he knows of it, work upon him sopowerfully through the imagination that he becomes very illindeed, and only through a more powerful magic exercised bysomeone else can the Hoodoo be taken off.

To primitive man life seemed "full of sacred presences" (WalterPater) connected with objects in nature, or with incidents andepochs in life, which he began early to deify, so that, until aquite recent period, his story is largely associated with apantheon of greater and lesser gods, which he has manufacturedwholesale. Xenophanes was the earliest philosopher to recognizeman's practice of making gods in his own image and endowing themwith human faculties and attributes; the Thracians, he said, madetheir gods blue-eyed and red-haired, the Ethiopians, snub-nosedand black, while, if oxen and lions and horses had hands andcould draw, they would represent their gods as oxen and lions andhorses. In relation to nature and to disease, all through earlyhistory we find a pantheon full to repletion, bearing testimonyno less to the fertility of man's imagination than to the hopesand fears which led him, in his exodus from barbarism, to regardhis gods as "pillars of fire by night, and pillars of cloud byday."

Even so late a religion as that of Numa was full of little godsto be invoked on special occasions--Vatican, who causes theinfant to utter his first cry, Fabulinus, who prompts his firstword, Cuba, who keeps him quiet in his cot, Domiduca, who watchesover one's safe home-coming (Walter Pater); and Numa believedthat all diseases came from the gods and were to be averted byprayer and sacrifice. Besides the major gods, representatives ofApollo, AEsculapius and Minerva, there were scores of lesser oneswho could be invoked for special diseases. It is said that theyoung Roman mother might appeal to no less than fourteengoddesses, from Juno Lucina to Prosa and Portvorta (Withington).Temples were erected to the Goddess of Fever, and she was muchinvoked. There is extant a touching tablet erected by a mourningmother and inscribed:

Febri divae, FebriSancte, Febri magnaeCamillo amato proFilio meld effecto. Posuit.

It is marvellous what a long line of superhuman powers, major andminor, man has invoked against sickness. In Swinburne's words:

God by God flits past in thunder till his glories turn to shades,God by God bears wondering witness how his Gospel flames andfades;

More was each of these, while yet they were, than man theirservant seemed;Dead are all of these, and man survives who made them while hedreamed.

Most of them have been benign and helpful gods. Into the darkchapters relating to demonical possession and to witchcraft wecannot here enter. They make one cry out with Lucretius (Bk. V):

O genus infelix humanum, talia divisCum tribuit facta atque iras adjunxit acerbas!Quantos tum gemitus ipsi sibi, quantaque nobisVulnera, quas lacrimas peperere minoribu' nostris.

In every age, and in every religion there has been justificationfor his bitter words, "tantum religio potuit suaderemalorum"--"Such wrongs Religion in her train doth bring"--yet,one outcome of "a belief in spiritual beings"--as Tylor definesreligion-- has been that man has built an altar of righteousnessin his heart. The comparative method applied to the study of hisreligious growth has shown how man's thoughts have widened in theunceasing purpose which runs through his spiritual no less thanhis physical evolution. Out of the spiritual protoplasm of magichave evolved philosopher and physician, as well as priest. Magicand religion control the uncharted sphere--the supernatural, thesuperhuman: science seeks to know the world, and through knowing,to control it. Ray Lankester remarks that Man is Nature's rebel,and goes on to say: "The mental qualities which have developed inMan, though traceable in a vague and rudimentary condition insome of his animal associates, are of such an unprecedented powerand so far dominate everything else in his activities as a livingorganism, that they have to a very large extent, if not entirely,cut him off from the general operation of that process of NaturalSelection and survival of the fittest which up to theirappearance had been the law of the living world. They justify theview that Man forms a new departure in the gradual unfolding ofNature's predestined scheme. Knowledge, reason,self-consciousness, will, are the attributes of Man."[1] It hasbeen a slow and gradual growth, and not until within the pastcentury has science organized knowledge-- so searched out thesecrets of Nature, as to control her powers, limit her scope andtransform her energies. The victory is so recent that the mentalattitude of the race is not yet adapted to the change. A largeproportion of our fellow creatures still regard nature as aplayground for demons and spirits to be exorcised or invoked.

[1] Sir E. Ray Lankester: Romanes Lecture, "Nature and Man,"Oxford Univ. Press, 1905, p. 21.

Side by side, as substance and shadow--"in the dark backward andabysm of time," in the dawn of the great civilizations of Egyptand Babylon, in the bright morning of Greece, and in the fullnoontide of modern life, together have grown up these twodiametrically opposite views of man's relation to nature, andmore particularly of his personal relation to the agencies of

disease.

The purpose of this course of lectures is to sketch the mainfeatures of the growth of these two dominant ideas, to show howthey have influenced man at the different periods of hisevolution, how the lamp of reason, so early lighted in his soul,burning now bright, now dim, has never, even in his darkestperiod, been wholly extinguished, but retrimmed and refurnishedby his indomitable energies, now shines more and more towards theperfect day. It is a glorious chapter in history, in which thosewho have eyes to see may read the fulfilment of the promise ofEden, that one day man should not only possess the earth, butthat he should have dominion over it! I propose to take anaeroplane flight through the centuries, touching only on the tallpeaks from which may be had a panoramic view of the epochsthrough which we pass.

ORIGIN OF MEDICINE

MEDICINE arose out of the primal sympathy of man with man; out ofthe desire to help those in sorrow, need and sickness.

In the primal sympathyWhich having been must ever be;In the soothing thoughts that springOut of human suffering.

The instinct of self-preservation, the longing to relieve a lovedone, and above all, the maternal passion--for such itis--gradually softened the hard race of man--tum genus humanumprimum mollescere coepit. In his marvellous sketch of theevolution of man, nothing illustrates more forcibly theprescience of Lucretius than the picture of the growth ofsympathy: "When with cries and gestures they taught with brokenwords that 'tis right for all men to have pity on the weak." Iheard the well-known medical historian, the late Dr. Payne,remark that "the basis of medicine is sympathy and the desire tohelp others, and whatever is done with this end must be calledmedicine."

The first lessons came to primitive man by injuries, accidents,bites of beasts and serpents, perhaps for long ages notappreciated by his childlike mind, but, little by little, suchexperiences crystallized into useful knowledge. The experimentsof nature made clear to him the relation of cause and effect, butit is not likely, as Pliny suggests, that he picked up hisearliest knowledge from the observation of certain practices inanimals, as the natural phlebotomy of the plethoric hippopotamus,or the use of emetics from the dog, or the use of enemata fromthe ibis. On the other hand, Celsus is probably right in hisaccount of the origin of rational medicine. "Some of the sick onaccount of their eagerness took food on the first day, some onaccount of loathing abstained; and the disease in those whorefrained was more relieved. Some ate during a fever, some alittle before it, others after it had subsided, and those who hadwaited to the end did best. For the same reason some at the

beginning of an illness used a full diet, others a spare, and theformer were made worse. Occurring daily, such things impressedcareful men, who noted what had best helped the sick, then beganto prescribe them. In this way medicine had its rise from theexperience of the recovery of some, of the death of others,distinguishing the hurtful from the salutary things" (Book I).The association of ideas was suggestive--the plant eyebright wasused for centuries in diseases of the eye because a black speckin the flower suggested the pupil of the eye. The old herbals arefull of similar illustrations upon which, indeed, the so-calleddoctrine of signatures depends. Observation came, and with it anever widening experience. No society so primitive without someevidence of the existence of a healing art, which grew with itsgrowth, and became part of the fabric of its organization.

With primitive medicine, as such, I cannot deal, but I must referto the oldest existing evidence of a very extraordinary practice,that of trephining. Neolithic skulls with disks of bone removedhave been found in nearly all parts of the world. Many carefulstudies have been made of this procedure, particularly by thegreat anatomist and surgeon, Paul Broca, and M.Lucas-Championniere has covered the subject in a monograph.[2]Broca suggests that the trephining was done by scratching orscraping, but, as Lucas-Championniere holds, it was also done bya series of perforations made in a circle with flint instruments,and a round piece of skull in this way removed; traces of thesedrill-holes have been found. The operation was done for epilepsy,infantile convulsions, headache, and various cerebral diseasesbelieved to be caused by confined demons, to whom the hole gave aready method of escape.

[2] Lucas-Championniere: Trepanation neolithique, Paris, 1912.

The practice is still extant. Lucas-Championniere saw a Kabylethoubib who told him that it was quite common among his tribe; hewas the son of a family of trephiners, and had undergone theoperation four times, his father twelve times; he had threebrothers also experts; he did not consider it a dangerousoperation. He did it most frequently for pain in the head, andoccasionally for fracture.

The operation was sometimes performed upon animals. Shepherdstrephined sheep for the staggers. We may say that the moderndecompression operation, so much in vogue, is the oldest knownsurgical procedure.

EGYPTIAN MEDICINE

OUT of the ocean of oblivion, man emerges in history in a highlycivilized state on the banks of the Nile, some sixty centuriesago. After millenniums of a gradual upward progress, which can betraced in the records of the stone age, civilization springsforth Minerva-like, complete, and highly developed, in the NileValley. In this sheltered, fertile spot, neolithic man firstraised himself above his kindred races of the Mediterranean

basin, and it is suggested that by the accidental discovery ofcopper Egypt "forged the instruments that raised civilization outof the slough of the Stone Age" (Elliot Smith). Of specialinterest to us is the fact that one of the best-known names ofthis earliest period is that of a physician--guide, philosopherand friend of the king--a man in a position of wide trust andimportance. On leaving Cairo, to go up the Nile, one sees on theright in the desert behind Memphis a terraced pyramid 190 feet inheight, "the first large structure of stone known in history." Itis the royal tomb of Zoser, the first of a long series with whichthe Egyptian monarchy sought "to adorn the coming bulk of death."The design of this is attributed to Imhotep, the first figure ofa physician to stand out clearly from the mists of antiquity. "Inpriestly wisdom, in magic, in the formulation of wise proverbs,in medicine and architecture, this remarkable figure of Zoser'sreign left so notable a reputation that his name was neverforgotten, and 2500 years after his death he had become a God ofMedicine, in whom the Greeks, who called him Imouthes, recognizedtheir own AEsculapius."[3] He became a popular god, not onlyhealing men when alive, but taking good care of them in thejourneys after death. The facts about this medicinae primusinventor, as he has been called, may be gathered from KurtSethe's study.[4] He seems to have corresponded very much to theGreek Asklepios. As a god he is met with comparatively late,between 700 and 332 B.C. Numerous bronze figures of him remain.The oldest memorial mentioning him is a statue of one of hispriests, Amasis (No. 14765 in the British Museum). Ptolemy Vdedicated to him a temple on the island of Philae. His cultincreased much in later days, and a special temple was dedicatedto him near Memphis Sethe suggests that the cult of Imhotep gavethe inspiration to the Hermetic literature. The association ofImhotep with the famous temple at Edfu is of special interest.

[3] Breasted: A History of the Ancient Egyptians, Scribner, NewYork, 1908, p. 104.

[4] K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig, 1909(Untersuchungen, etc., ed. Sethe, Vol. II, No. 4).

Egypt became a centre from which civilization spread to the otherpeoples of the Mediterranean. For long centuries, to be learnedin all the wisdom of the Egyptians meant the possession of allknowledge. We must come to the land of the Nile for the origin ofmany of man's most distinctive and highly cherished beliefs. Notonly is there a magnificent material civilization, but in recordsso marvellously preserved in stone we may see, as in a glass,here clearly, there darkly, the picture of man's search afterrighteousness, the earliest impressions of his moral awakening,the beginnings of the strife in which he has always been engagedfor social justice and for the recognition of the rights of theindividual. But above all, earlier and more strongly than in anyother people, was developed the faith that looked through death,to which, to this day, the noblest of their monuments bear anenduring testimony. With all this, it is not surprising to find agrowth in the knowledge of practical medicine; but Egyptiancivilization illustrates how crude and primitive may remain a

knowledge of disease when conditioned by erroneous views of itsnature. At first, the priest and physician were identified, andmedicine never became fully dissociated from religion. Only inthe later periods did a special group of physicians arise whowere not members of priestly colleges.[6] Maspero states that theEgyptians believed that disease and death were not natural andinevitable, but caused by some malign influence which could useany agency, natural or invisible, and very often belonged to theinvisible world. "Often, though, it belongs to the invisibleworld, and only reveals itself by the malignity of its attacks:it is a god, a spirit, the soul of a dead man, that has cunninglyentered a living person, or that throws itself upon him withirresistible violence. Once in possession of the body, the evilinfluence breaks the bones, sucks out the marrow, drinks theblood, gnaws the intestines and the heart and devours the flesh.The invalid perishes according to the progress of thisdestructive work; and death speedily ensues, unless the evilgenius can be driven out of it before it has committedirreparable damage. Whoever treats a sick person has thereforetwo equally important duties to perform. He must first discoverthe nature of the spirit in possession, and, if necessary, itsname, and then attack it, drive it out, or even destroy it. Hecan only succeed by powerful magic, so he must be an expert inreciting incantations, and skilful in making amulets. He mustthen use medicine [drugs and diet] to contend with the disorderswhich the presence of the strange being has produced in thebody."[6]

[5] Maspero: Life in Ancient Egypt and Assyria, London, 1891, p.119.

[6] Maspero: Life in Ancient Egypt and Assyria, London, 1891, p.118.

[7] W. Wreszinski: Die Medizin der alten Aegypter, Leipzig, J.C. Hinrichs, 1909-1912.

In this way it came about that diseases were believed to be dueto hostile spirits, or caused by the anger of a god, so thatmedicines, no matter how powerful, could only be expected toassuage the pain; but magic alone, incantations, spells andprayers, could remove the disease. Experience brought much of thewisdom we call empirical, and the records, extending forthousands of years, show that the Egyptians employed emetics,purgatives, enemata, diuretics, diaphoretics and even bleeding.They had a rich pharmacopoeia derived from the animal, vegetableand mineral kingdoms. In the later periods, specialism reached aremarkable development, and Herodotus remarks that the countrywas full of physicians;--"One treats only the diseases of theeye, another those of the head, the teeth, the abdomen, or theinternal organs."

Our knowledge of Egyptian medicine is derived largely from theremarkable papyri dealing specially with this subject. Of these,six or seven are of the first importance. The most famous is thatdiscovered by Ebers, dating from about 1500 B.C. A superb

document, one of the great treasures of the Leipzig Library, itis 20.23 metres long and 30 centimetres high and in a state ofwonderful preservation. Others are the Kahun, Berlin, Hearst andBritish Museum papyri. All these have now been published--thelast three quite recently, edited by Wreszinski.[7] I show here areproduction from which an idea may be had of these remarkabledocuments. They are motley collections, filled with incantations,charms, magical formulae, symbols, prayers and prescriptions forall sorts of ailments. One is impressed by the richness of thepharmacopoeia, and the high development which the art of pharmacymust have attained. There were gargles, salves, snuffs,inhalations, suppositories, fumigations, enemata, poultices andplasters; and they knew the use of opium, hemlock, the coppersalts, squills and castor oil. Surgery was not very highlydeveloped, but the knife and actual cautery were freely used.Ophthalmic surgery was practiced by specialists, and there aremany prescriptions in the papyri for ophthalmia.

One department of Egyptian medicine reached a high stage ofdevelopment, vis., hygiene. Cleanliness of the dwellings, of thecities and of the person was regulated by law, and the priestsset a splendid example in their frequent ablutions, shaving ofthe entire body, and the spotless cleanliness of their clothing.As Diodorus remarks, so evenly ordered was their whole manner oflife that it was as if arranged by a learned physician ratherthan by a lawgiver.

Two world-wide modes of practice found their earliestillustration in ancient Egypt. Magic, the first of these,represented the attitude of primitive man to nature, and reallywas his religion. He had no idea of immutable laws, but regardedthe world about him as changeable and fickle like himself, and"to make life go as he wished, he must be able to please andpropitiate or to coerce these forces outside himself."[8]

[8] L. Thorndike: The Place of Magic in the Intellectual Historyof Europe, New York, 1905, p. 29.

The point of interest to us is that in the Pyramid Texts--"theoldest chapter in human thinking preserved to us, the remotestreach in the intellectual history of man which we are now able todiscern"[9]-- one of their six-fold contents relates to thepractice of magic. A deep belief existed as to its efficacy,particularly in guiding the dead, who were said to be glorious byreason of mouths equipped with the charms, prayers and ritual ofthe Pyramid Texts, armed with which alone could the soul escapethe innumerable dangers and ordeals of the passage throughanother world. Man has never lost his belief in the efficacy ofmagic, in the widest sense of the term. Only a very few of themost intellectual nations have escaped from its shackles. Nobodyelse has so clearly expressed the origins and relations of magicas Pliny in his "Natural History."[10] "Now, if a man considerthe thing well, no marvaile it is that it hath continued thus inso great request and authoritie; for it is the onely Sciencewhich seemeth to comprise in itselfe three possessions besides,which have the command and rule of mans mind above any other

whatsoever. For to begin withall, no man doubteth but thatMagicke tooke root first, and proceeded from Physicke, under thepresence of maintaining health, curing, and preventing diseases:things plausible to the world, crept and insinuated farther intothe heart of man, with a deepe conceit of some high and divinematter therein more than ordinarie, and in comparison whereof,all other Physicke was but basely accounted. And having thus madeway and entrance, the better to fortifie it selfe, and to give agoodly colour and lustre to those fair and flattering promises ofthings, which our nature is most given to hearken after, on goeththe habite also and cloake of religion: a point, I may tell you,that even in these daies holdeth captivate the spirit of man, anddraweth away with it a greater part of the world, and nothing somuch. But not content with this successe and good proceeding, togather more strength and win a greater name, shee entermingledwith medicinable receipts and religious ceremonies, the skill ofAstrologie and arts Mathematicall; presuming upon this, That allmen by nature are very curious and desirous to know their futurefortunes, and what shall betide them hereafter, persuadingthemselves, that all such foreknowledge dependeth upon the courseand influence of the starres, which give the truest and mostcertain light of things to come. Being thus wholly possessed ofmen, and having their senses and understanding by this meanesfast ynough bound with three sure chains, no marvell if this artgrew in processe of time to such an head, that it was and is atthis day reputed by most nations of the earth for the paragon andcheefe of all sciences: insomuch as the mightie kings andmonarchs of the Levant are altogether ruled and governedthereby."

[9] Breasted: Development of Religion and Thought in AncientEgypt, New York, 1912, p. 84.

[10] The Historie of the World, commonly called the NaturallHistorie of C. Plinius Secundus, translated into English byPhilemon Holland, Doctor in Physieke, London, 1601, Vol. II, p.371, Bk. XXX, Chap. I, Sect. 1.

The second world-wide practice which finds its earliest recordamong the Egyptians is the use secretions and parts of the animalbody as medicine. The practice was one of great antiquity withprimitive man, but the papyri already mentioned contain theearliest known records. Saliva, urine, bile, faeces, variousparts of the body, dried and powdered, worms, insects, snakeswere important ingredients in the pharmacopoeia. The practicebecame very widespread throughout the ancient world. Its extentand importance may be best gathered from chapters VII and VIII inthe 28th book of Pliny's "Natural History." Several remedies arementioned as derived from man; others from the elephant, lion,camel, crocodile, and some seventy-nine are prepared from thehyaena. The practice was widely prevalent throughout the MiddleAges, and the pharmacopoeia of the seventeenth and even of theeighteenth century contains many extraordinary ingredients. "TheRoyal Pharmacopoeia" of Moses Charras (London ed., 1678), themost scientific work of the day, is full of organotherapy anddirections for the preparation of medicines from the most

loathsome excretions. A curious thing is that with thediscoveries of the mummies a belief arose as to the greatefficacy of powdered mummy in various maladies. As Sir ThomasBrowne remarks in his "Urn Burial": "Mummy has becomemerchandize. Mizraim cures wounds, and Pharaoh is sold forbalsams."

One formula in everyday use has come to us in a curious way fromthe Egyptians. In the Osiris myth, the youthful Horus loses aneye in his battle with Set. This eye, the symbol of sacrifice,became, next to the sacred beetle, the most common talisman ofthe country, and all museums are rich in models of the Horus eyein glass or stone.

"When alchemy or chemistry, which had its cradle in Egypt, andderived its name from Khami, an old title for this country,passed to the hands of the Greeks, and later of the Arabs, thissign passed with it. It was also adopted to some extent by theGnostics of the early Christian church in Egypt. In a cursiveform it is found in mediaeval translations of the works ofPtolemy the astrologer, as the sign of the planet Jupiter. Assuch it was placed upon horoscopes and upon formula containingdrugs made for administration to the body, so that the harmfulproperties of these drugs might be removed under the influence ofthe lucky planet. At present, in a slightly modified form, itstill figures at the top of prescriptions written daily in GreatBritain (Rx)."[11]

[11] John D. Comrie: Medicine among the Assyrians and Egyptiansin 1500 B.C., Edinburgh Medical Journal, 1909, n. s., II, 119.

For centuries Egyptian physicians had a great reputation, and inthe Odyssey (Bk. IV), Polydamna, the wife of Thonis, givesmedicinal plants to Helen in Egypt--"a country producing aninfinite number of drugs . . . where each physician possessesknowledge above all other men." Jeremiah (xlvi, 11) refers tothe virgin daughter of Egypt, who should in vain use manymedicines. Herodotus tells that Darius had at his court certainEgyptians, whom he reckoned the best skilled physicians in allthe world, and he makes the interesting statement that: "Medicineis practiced among them on a plan of separation; each physiciantreats a single disorder, and no more: thus the country swarmswith medical practitioners, some under taking to cure diseases ofthe eye, others of the head, others again of the teeth, others ofthe intestines, and some those which are not local."[12]

[12] The History of Herodotus, Blakesley's ed., Bk. II, 84.

A remarkable statement is made by Pliny, in the discussion uponthe use of radishes, which are said to cure a "Phthisicke," orulcer of the lungs--"proofe whereof was found and seen in AEgyptby occasion that the KK. there, caused dead bodies to be cut up,and anatomies to be made, for to search out the maladies whereofmen died."[13]

[13 Pliny, Holland's translation, Bk. XIX, Chap. V, Sect. 26.

The study of the anatomy of mummies has thrown a very interestinglight upon the diseases of the ancient Egyptians, one of the mostprevalent of which appears to have been osteo-arthritis. This hasbeen studied by Elliot Smith, Wood Jones, Ruffer and Rietti. Themajority of the lesions appear to have been the commonosteo-arthritis, which involved not only the men, but many of thepet animals kept in the temples. In a much higher proportionapparently than in modern days, the spinal column was involved.It is interesting to note that the "determinative" of old age inhieroglyphic writing is the picture of a man afflicted witharthritis deformans. Evidences of tuberculosis, rickets andsyphilis, according to these authors, have not been found.

A study of the internal organs has been made by Ruffer, who hasshown that arterio-sclerosis with calcification was a commondisease 8500 years ago; and he holds that it could not have beenassociated with hard work or alcohol, for the ancient Egyptiansdid not drink spirits, and they had practically the same hours ofwork as modern Egyptians, with every seventh day free.

ASSYRIAN AND BABYLONIAN MEDICINE

OF equally great importance in the evolution of medicine was thepractically contemporary civilization in Mesopotamia. Sciencehere reached a much higher stage then in the valley of the Nile.An elaborate scheme of the universe was devised, a system growingout of the Divine Will, and a recognition for the first time of alaw guiding and controlling heaven and earth alike. Here, too,we find medicine ancillary to religion. Disease was due to evilspirits or demons. "These 'demons'--invisible to the naked eyewere the precursors of the modern 'germs' and 'microbes,' whilethe incantations recited by the priests are the early equivalentsof the physician's prescriptions. There were differentincantations for different diseases; and they were as mysteriousto the masses as are the mystic formulas of the modern physicianto the bewildered, yet trusting, patient. Indeed, theirmysterious character added to the power supposed to reside in theincantations for driving the demons away. Medicinal remediesaccompanied the recital of the incantations, but despite theconsiderable progress made by such nations of hoary antiquity asthe Egyptians and Babylonians in the diagnosis and treatment ofcommon diseases, leading in time to the development of anextensive pharmacology, so long as the cure of disease restedwith the priests, the recital of sacred formulas, together withrites that may be conveniently grouped under the head ofsympathetic magic, was regarded as equally essential with thetaking of the prescribed remedies."[14]

[14] Morris Jastrow: The Liver in Antiquity and the Beginningsof Anatomy. Transactions College of Physicians, Philadelphia,1907, 3. s., XXIX, 117-138.

Three points of interest may be referred to in connection withBabylonian medicine. Our first recorded observations on anatomyare in connection with the art of divination-- the study of thefuture by the interpretation of certain signs. The studentrecognized two divisions of divination-- the involuntary, dealingwith the interpretation of signs forced upon our attention, suchas the phenomena of the heavens, dreams, etc., and voluntarydivination, the seeking of signs, more particularly through theinspection of sacrificial animals. This method reached anextraordinary development among the Babylonians, and the cultspread to the Etruscans, Hebrews, and later to the Greeks andRomans.

Of all the organs inspected in a sacrificial animal the liver,from its size, position and richness in blood, impressed theearly observers as the most important of the body. Probably onaccount of the richness in blood it came to be regarded as theseat of life--indeed, the seat of the soul. From this importantposition the liver was not dislodged for many centuries, and inthe Galenic physiology it shared with the heart and the brain inthe triple control of the natural, animal and vital spirits. Manyexpressions in literature indicate how persistent was thisbelief. Among the Babylonians, the word "liver" was used in hymnsand other compositions precisely as we use the word "heart," andJastrow gives a number of illustrations from Hebrew, Greek andLatin sources illustrating this usage.

The belief arose that through the inspection of this importantorgan in the sacrificial animal the course of future events couldbe predicted. "The life or soul, as the seat of life, in thesacrificial animal is, therefore, the divine element in theanimal, and the god in accepting the animal, which is involved inthe act of bringing it as an offering to a god, identifieshimself with the animal--becomes, as it were, one with it. Thelife in the animal is a reflection of his own life, and since thefate of men rests with the gods, if one can succeed in enteringinto the mind of a god, and thus ascertain what he purposes todo, the key for the solution of the problem as to what the futurehas in store will have been found. The liver being the centre ofvitality--the seat of the mind, therefore, as well as of theemotions--it becomes in the case of the sacrificial animal,either directly identical with the mind of the god who acceptsthe animal, or, at all events, a mirror in which the god's mindis reflected; or, to use another figure, a watch regulated to bein sympathetic and perfect accord with a second watch. If,therefore, one can read the liver of the sacrificial animal, oneenters, as it were, into the workshop of the divine will."[15]

[15] Morris Jastrow: loc. cit., p. 122.

Hepatoscopy thus became, among the Babylonians, of extraordinarycomplexity, and the organ of the sheep was studied and figured asearly as 3000 B.C. In the divination rites, the lobes, thegall-bladder, the appendages of the upper lobe and the markingswere all inspected with unusual care. The earliest knownanatomical model, which is here shown, is the clay model of a

sheep's liver with the divination text dating from about 2000B.C., from which Jastrow has worked out the modern anatomicalequivalents of the Babylonian terms. To reach a decision on anypoint, the phenomena of the inspection of the liver werecarefully recorded, and the interpretations rested on a more orless natural and original association of ideas. Thus, if thegall-bladder were swollen on the right side, it pointed to anincrease in the strength of the King's army, and was favorable;if on the left side, it indicated rather success of the enemy,and was unfavorable. If the bile duct was long, it pointed to along life. Gallstones are not infrequently mentioned in thedivination texts and might be favorable, or unfavorable. Variousinterpretations were gathered by the scribes in the referencenote-books which serve as guides for the interpretation of theomens and for text-books of instructions in the temple schools(Jastrow).

The art of divination spread widely among the neighboringnations. There are many references in the Bible to the practice.The elders of Moab and Midian came to Balaam "with the rewards ofdivination in their hand" (Numbers xxii, 7). Joseph's cup ofdivination was found in Benjamin's sack (Genesis xliv, 5, 12);and in Ezekiel (xxi, 21) the King of Babylon stood at the partingof the way and looked in the liver. Hepatoscopy was alsopracticed by the Etruscans, and from them it passed to the Greeksand the Romans, among whom it degenerated into a more or lessmeaningless form. But Jastrow states that in Babylonia andAssyria, where for several thousand years the liver wasconsistently employed as the sole organ of divination, there areno traces of the rite having fallen into decay, or having beenabused by the priests.

In Roman times, Philostratus gives an account of the trial ofApollonius of Tyana,[16] accused of human hepatoscopy bysacrificing a boy in the practice of magic arts against theEmperor. "The liver, which the experts say is the very tripod oftheir art, does not consist of pure blood; for the heart retainsall the uncontaminated blood, and irrigates the whole body withit by the conduits of the arteries; whereas the gall, which issituated next the liver, is stimulated by anger and depressed byfear into the hollows of the liver."

We have seen how early and how widespread was the belief inamulets and charms against the occult powers of darkness. Onethat has persisted with extraordinary tenacity is the belief inthe Evil Eye the power of certain individuals to injure with alook. Of general belief in the older civilizations, and referredto in several places in the Bible, it passed to Greece and Rome,and today is still held fervently in many parts of Europe. Thesign of "le corna,"--the first and fourth fingers extended, theothers turned down and the thumb closed over them,--still usedagainst the Evil Eye in Italy, was a mystic sign used by theRomans in the festival of Lemuralia. And we meet with the beliefalso in this country. A child with hemiplegia, at the Infirmaryfor Diseases of the Nervous System, Philadelphia, from thecentral part of Pennsylvania, was believed by its parents to havehad the Evil Eye cast upon it.

The second contribution of Babylonia and Assyria to medicine--one that affected mankind profoundly--relates to the supposedinfluence of the heavenly bodies upon man's welfare. A beliefthat the stars in their courses fought for or against him aroseearly in their civilizations, and directly out of their studieson astrology and mathematics. The Macrocosm, the heavens that"declare the glory of God," reflect, as in a mirror, theMicrocosm, the daily life of man on earth. The first step was theidentification of the sun, moon and stars with the gods of thepantheon. Assyrian astronomical observations show anextraordinary development of practical knowledge. The movementsof the sun and moon and of the planets were studied; theAssyrians knew the precession of the equinoxes and many of thefundamental laws of astronomy, and the modern nomenclature datesfrom their findings. In their days the signs of the zodiaccorresponded practically with the twelve constellations whosenames they still bear, each division being represented by thesymbol of some god, as the Scorpion, the Ram, the Twins, etc."Changes in the heavens . . . portended changes on earth. TheBiblical expression 'hosts of heaven' for the starry universeadmirably reflects the conception held by the Babylonianastrologers. Moon, planets and stars constituted an army inconstant activity, executing military manoeuvres which were theresult of deliberation and which had in view a fixed purpose. Itwas the function of the priest-- the barqu, or 'inspector,' asthe astrologer as well as the 'inspector' of the liver wascalled--to discover this purpose. In order to do so, a system ofinterpretation was evolved, less logical and less elaborate thanthe system of hepatoscopy, which was analyzed in the precedingchapter, but nevertheless meriting attention both as an exampleof the pathetic yearning of men to peer into the minds of thegods, and of the influence that Babylonian-Assyrian astrologyexerted throughout the ancient world" (Jastrow).[17]

[16] Philostratus: Apollonius of Tyana, Bk. VIII, Chap. VII,Phillimore's transl., Oxford, 1912, II, 233. See, also, Justin:Apologies, edited by Louis Pautigny, Paris, 1904, p. 39.

[17] M. Jastrow: Aspects of Religious Belief and Practice inBabylonia and Assyria, New York, 1911, p. 210.

With the rationalizing influence of the Persians the hold ofastrology weakened, and according to Jastrow it was this, incombination with Hebrew and Greek modes of thought, that led thepriests in the three centuries following the Persian occupation,to exchange their profession of diviners for that of astronomers;and this, he says, marks the beginning of the conflict betweenreligion and science. At first an expression of primitive"science," astrology became a superstition, from which the humanmind has not yet escaped. In contrast to divination, astrologydoes not seem to have made much impression on the Hebrews anddefinite references in the Bible are scanty. From Babylonia itpassed to Greece (without, however, exerting any particularinfluence upon Greek medicine). Our own language is rich in wordsof astral significance derived from the Greek, e.g., disaster.

The introduction of astrology into Europe has a passing interest.Apparently the Greeks had made important advances in astronomybefore coming in contact with the Babylonians,--who, in allprobability, received from the former a scientific conception ofthe universe. "In Babylonia and Assyria we have astrology firstand astronomy afterwards, in Greece we have the sequencereversed--astronomy first and astrology afterwards"(Jastrow).[18]

[18] M. Jastrow: Aspects of Religious Belief and Practice inBabylonia and Assyria, New York, 1911, p. 256.

It is surprising to learn that, previous to their contact withthe Greeks, astrology as relating to the individual-- that is tosay, the reading of the stars to determine the conditions underwhich the individual was born--had no place in the cult of theBabylonians and Assyrians. The individualistic spirit led theGreek to make his gods take note of every action in his life, andhis preordained fate might be read in the stars.--"A connectinglink between the individual and the movements in the heavens wasfound in an element which they shared in common. Both man andstars moved in obedience to forces from which there was noescape. An inexorable law controlling the planets corresponded toan equally inexorable fate ordained for every individual from hisbirth. Man was a part of nature and subject to its laws. Thethought could therefore arise that, if the conditions in theheavens were studied under which a man was born, that man'sfuture could be determined in accord with the beliefs associatedwith the position of the planets rising or visible at the time ofbirth or, according to other views, at the time of conception.These views take us back directly to the system of astrologydeveloped by Babylonian baru priests. The basis on which themodified Greek system rests is likewise the same that we haveobserved in Babylonia--a correspondence between heaven and earth,but with this important difference, that instead of the capriceof the gods we have the unalterable fate controlling the entireuniverse--the movements of the heavens and the life of theindividual alike" (Jastrow).[19]

[19] Ibid., pp. 257-258.

From this time on until the Renaissance, like a shadow, astrologyfollows astronomy. Regarded as two aspects of the same subject,the one, natural astrology, the equivalent of astronomy, wasconcerned with the study of the heavens, the other, judicialastrology, was concerned with the casting of horoscopes, andreading in the stars the fate of the individual.

As I mentioned, Greek science in its palmy days seems to havebeen very free from the bad features of astrology. GilbertMurray remarks that "astrology fell upon the Hellenistic mind asa new disease falls upon some remote island people." But in theGreek conquest of the Roman mind, astrology took a prominentrole. It came to Rome as part of the great Hellenizing movement,

and the strength of its growth may be gauged from the edictsissued against astrologers as early as the middle of the secondcentury B.C. In his introduction to his recent edition of Book IIof the Astronomicon of Manilius, Garrod traces the growth of thecult, which under the Empire had an extraordinary vogue. "Thoughthese [heavenly] signs be far removed from us, yet does he [thegod] so make their influences felt, that they give to nationstheir life and their fate and to each man his own character."[20]Oracles were sought on all occasions, from the planting of a treeto the mating of a horse, and the doctrine of the starsinfluenced deeply all phases of popular thought and religion.The professional astrologers, as Pliny[21] says, were Chaldeans,Egyptians and Greeks. The Etruscans, too, the professionaldiviners of Rome, cultivated the science. Many of these "Isiaciconjectores" and "astrologi de circo" were worthless charlatans,but on the whole the science seems to have attracted theattention of thoughtful men of the period. Garrod quotes thefollowing remarkable passage from Tacitus: "My judgment wavers,"he says, "I dare not say whether it be fate and necessityimmutable which governs the changing course of human affairs--orjust chance. Among the wisest of the ancients, as well as amongtheir apes, you will find a conflict of opinion. Many holdfixedly the idea that our beginning and our end--that manhimself--is nothing to the Gods at all. The wicked are inprosperity and the good meet tribulation. Others believe thatFate and the facts of this world work together. But thisconnection they trace not to planetary influences but to aconcatenation of natural causes. We choose our life that isfree: but the choice once made, what awaits us is fixed andordered. Good and evil are different from the vulgar opinion ofthem. Often those who seem to battle with adversity are to beaccounted blessed; but the many, even in their prosperity, aremiserable. It needs only to bear misfortune bravely, while thefool perishes in his wealth. Outside these rival schools standsthe man in the street. No one will take from him his convictionthat at our birth are fixed for us the things that shall be. Ifsome things fall out differently from what was foretold, that isdue to the deceit of men that speak what they know not: callinginto contempt a science to which past and present alike bear aglorious testimony" (Ann. vi, 22).

[20] Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford,1911, p. lxix, and II, ll. 84-86.

[21] Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect. 57.

Cato waged war on the Greek physicians and forbade "his uilicusall resort to haruspicem, augurem, hariolum Chaldaeum," but invain; so widespread became the belief that the great philosopher,Panaetius (who died about 111 B.C.), and two of his friends aloneamong the stoics, rejected the claims of astrology as a science(Garrod). So closely related was the subject of mathematics thatit, too, fell into disfavor, and in the Theodosian code sentenceof death was passed upon mathematicians. Long into the MiddleAges, the same unholy alliance with astrology and divination

caused mathematics to be regarded with suspicion, and evenAbelard calls it a nefarious study.

The third important feature in Babylonian medicine is theevidence afforded by the famous Hammurabi Code (circa 2000B.C.)-- a body of laws, civil and religious, many of which relateto the medical profession. This extraordinary document is ablack diorite block 8 feet high, once containing 21 columns onthe obverse, 16 and 28 columns on the reverse, with 2540 lines ofwriting of which now 1114 remain, and surmounted by the figure ofthe king receiving the law from the Sun-god. Copies of this wereset up in Babylon "that anyone oppressed or injured, who had atale of woe to tell, might come and stand before his image, thatof a king of righteousness, and there read the priceless ordersof the King, and from the written monument solve his problem"(Jastrow). From the enactments of the code we gather that themedical profession must have been in a highly organized state,for not only was practice regulated in detail, but a scale offees was laid down, and penalties exacted for malpraxis.Operations were performed, and the veterinary art was recognized.An interesting feature, from which it is lucky that we have inthese days escaped, is the application of the "lex talionis"-- aneye for an eye, bone for a bone, and tooth for a tooth, which isa striking feature of the code.

Some of the laws of the code may be quoted:

Paragraph 215. If a doctor has treated a gentleman for a severewound with a bronze lances and has cured the man, or has openedan abscess of the eye for a gentleman with the bronze lances andhas cured the eye of the gentleman, he shall take ten shekels ofsilver.

218. If the doctor has treated a gentleman for a severe woundwith a lances of bronze and has caused the gentleman to die, orhas opened an abscess of the eye for a gentleman and has causedthe loss of the gentleman's eye, one shall cut off his hands.

219. If a doctor has treated the severe wound of a slave of apoor man with a bronze lances and has caused his death, he shallrender slave for slave.

220. If he has opened his abscess with a bronze lances and hasmade him lose his eye, he shall pay money, half his price.

221. If a doctor has cured the shattered limb of a gentleman, orhas cured the diseased bowel, the patient shall give five shekelsof silver to the doctor.

224. If a cow doctor or a sheep doctor has treated a cow or asheep for a severe wound and cured it, the owner of the cow orsheep shall give one-sixth of a shekel of silver to the doctor ashis fee.[22]

[22] The Oldest Code of Laws in the World; translated by C. H. W.

Johns, Edinburgh, 1903.

HEBREW MEDICINE

THE medicine of the Old Testament betrays both Egyptian andBabylonian influences; the social hygiene is a reflex ofregulations the origin of which may be traced in the PyramidTexts and in the papyri. The regulations in the Pentateuch codesrevert in part to primitive times, in part represent advancedviews of hygiene. There are doubts if the Pentateuch code reallygoes back to the days of Moses, but certainly someone "learned inthe wisdom of the Egyptians" drew it up. As Neuburger brieflysummarizes:

"The commands concern prophylaxis and suppression of epidemics,suppression of venereal disease and prostitution, care of theskin, baths, food, housing and clothing, regulation of labour,sexual life, discipline of the people, etc. Many of thesecommands, such as Sabbath rest, circumcision, laws concerningfood (interdiction of blood and pork), measures concerningmenstruating and lying-in women and those suffering fromgonorrhoea, isolation of lepers, and hygiene of the camp, are, inview of the conditions of the climate, surprisinglyrational."[23]

[23] Neuburger: History of Medicine, Oxford University Press,1910, Vol. I, p. 38.

Divination, not very widely practiced, was borrowed, no doubt,from Babylonia. Joseph's cup was used for the purpose, and inNumbers, the elders of Balak went to Balaam with the rewards ofdivination in their hands. The belief in enchantments andwitchcraft was universal, and the strong enactments againstwitches in the Old Testament made a belief in them almostimperative until more rational beliefs came into vogue in theeighteenth and nineteenth centuries.

Whatever view we may take of it, the medicine of the NewTestament is full of interest. Divination is only referred toonce in the Acts (xvi, 16), where a damsel is said to bepossessed of a spirit of divination "which brought her mastersmuch gain by soothsaying." There is only one mention ofastrology (Acts vii, 43); there are no witches, neither are therecharms or incantations. The diseases mentioned are numerous:demoniac possession, convulsions, paralysis, skin diseases,--asleprosy,--dropsy, haemorrhages, fever, fluxes, blindness anddeafness. And the cure is simple usually a fiat of the Lord,rarely with a prayer, or with the use of means such as spittle.They are all miraculous, and the same power was granted to theapostles--"power against unclean spirits, to cast them out, toheal all manner of sickness and all manner of disease." And morethan this, not only the blind received their sight, the lamewalked, the lepers were cleansed, the deaf heard, but even thedead were raised up. No question of the mandate. He who wentabout doing good was a physician of the body as well as of the

soul, and could the rich promises of the Gospel have beenfulfilled, there would have been no need of a new dispensation ofscience. It may be because the children of this world have neverbeen able to accept its hard sayings--the insistence uponpoverty, upon humility, upon peace that Christianity has losttouch no less with the practice than with the principles of itsFounder. Yet, all through the centuries, the Church has neverwholly abandoned the claim to apostolic healing; nor is there anyreason why she should. To the miraculous there should be no timelimit--only conditions have changed and nowadays to have amountain-moving faith is not easy. Still, the possession ischerished, and it adds enormously to the spice and variety oflife to know that men of great intelligence, for example, my goodfriend, Dr. James J. Walsh of New York, believe in the miraclesof Lourdes.[24] Only a few weeks ago, the Bishop of Londonfollowed with great success, it is said, the practice of St.James. It does not really concern us much--as Oriental views ofdisease and its cure have had very little influence on theevolution of scientific medicine--except in illustration of thepersistence of an attitude towards disease always widelyprevalent, and, indeed, increasing. Nor can we say that themedicine of our great colleague, St. Luke, the Beloved Physician,whose praise is in the Gospels, differs so fundamentally fromthat of the other writings of the New Testament that we can claimfor it a scientific quality. The stories of the miracles havetechnical terms and are in a language adorned by medicalphraseology, but the mental attitude towards disease is certainlynot that of a follower of Hippocrates, nor even of ascientifically trained contemporary of Dioscorides.[25]

[24] Psychotherapy, New York, 1919, p. 79, "I am convinced thatmiracles happen there. There is more than natural powermanifest."

[25] See Luke the Physician, by Harnack, English ed., 1907, andW. K. Hobart, The Medical Language of St. Luke, 1882.

CHINESE AND JAPANESE MEDICINE

CHINESE medicine illustrates the condition at which a highlyintellectual people may arrive, among whom thought andspeculation were restricted by religious prohibitions. Perhapsthe chief interest in its study lies in the fact that we may seetoday the persistence of views about disease similar to thosewhich prevailed in ancient Egypt and Babylonia. The Chinesebelieve in a universal animism, all parts being animated by godsand spectres, and devils swarm everywhere in numbersincalculable. The universe was spontaneously created by theoperation of its Tao, "composed of two souls, the Yang and theYin; the Yang represents light, warmth, production, and life, asalso the celestial sphere from which all those blessings emanate;the Yin is darkness, cold, death, and the earth, which, unlessanimated by the Yang or heaven, is dark, cold, dead. The Yang andthe Yin are divided into an infinite number of spiritsrespectively good and bad, called shen and kwei; every man andevery living being contains a shen and a kwei, infused at birth,

and departing at death, to return to the Yang and the Yin. Thusman with his dualistic soul is a microcosmos, born from theMacrocosmos spontaneously. Even every object is animated, aswell as the Universe of which it is a part."[26]

[26] J. J. M. de Groot: Religious System of China, Vol. VI,Leyden, 1910, p. 929.

In the animistic religion of China, the Wu represented a group ofpersons of both sexes, who wielded, with respect to the world ofspirits, capacities and powers not possessed by the rest of men.Many practitioners of Wu were physicians who, in addition tocharms and enchantments, used death-banishing medicinal herbs. Ofgreat antiquity, Wu-ism has changed in some ways its outwardaspect, but has not altered its fundamental characters. The Wu,as exorcising physicians and practitioners of the medical art,may be traced in classical literature to the time of Confucius.In addition to charms and spells, there were certain famous poemswhich were repeated, one of which, by Han Yu, of the T'ang epoch,had an extraordinary vogue. De Groot says that the "Ling," ormagical power of this poem must have been enormous, seeing thatits author was a powerful mandarin, and also one of the loftiestintellects China has produced. This poetic febrifuge istranslated in full by de Groot (VI, 1054-1055), and the demon offever, potent chiefly in the autumn, is admonished to begone tothe clear and limpid waters of the deep river.

In the High Medical College at Court, in the T'ang Dynasty, therewere four classes of Masters, attached to its two High MedicalChiefs: Masters of Medicine, of Acupuncture, of Manipulation,and two Masters for Frustration by means of Spells.

Soothsaying and exorcism may be traced far back to the fifth andsixth centuries B.C.

In times of epidemic the specialists of Wu-ism, who act as seers,soothsayers and exorcists, engage in processions, stripped to thewaist, dancing in a frantic, delirious state, covering themselveswith blood by means of prick-balls, or with needles thrustthrough their tongues, or sitting or stretching themselves onnail points or rows of sword edges. In this way they frightenthe spectres of disease. They are nearly all young, and arespoken of as "divining youths," and they use an exorcising magicbased on the principle that legions of spectres prone to evillive in the machine of the world. (De Groot, VI, 983-985.)

The Chinese believe that it is the Tao, or "Order of theUniverse," which affords immunity from evil, and according towhether or no the birth occurred in a beneficent year, dominatedby four double cyclical characters, the horoscope is "heavy" or"light." Those with light horoscopes are specially prone toincurable complaints, but much harm can be averted if such anindividual be surrounded with exorcising objects, if he be givenproper amulets to wear and proper medicines to swallow, and byselecting for him auspicious days and hours.

Two or three special points may be referred to. The doctrine ofthe pulse reached such extraordinary development that the wholepractice of the art centred round its different characters. Therewere scores of varieties, which in complication and detail put toconfusion the complicated system of some of the old Graeco-Romanwriters. The basic idea seems to have been that each part andorgan had its own proper pulse, and just as in a stringedinstrument each chord has its own tone, so in the human body, ifthe pulses were in harmony, it meant health; if there wasdiscord, it meant disease. These Chinese views reached Europe inthe seventeenth and eighteenth centuries, and there is a veryelaborate description of them in Floyer's well-known book.[27]And the idea of harmony in the pulse is met with into theeighteenth century.

[27] Sir John Floyer: The Physician's Pulse Watch, etc., London,1707.

Organotherapy was as extensively practiced in China as in Egypt.Parts of organs, various secretions and excretions are verycommonly used. One useful method of practice reached aremarkable development, viz., the art of acupuncture--thethrusting of fine needles more or less deeply into the affectedpart. There are some 388 spots on the body in which acupuncturecould be performed, and so well had long experience taught themas to the points of danger, that the course of the arteries maybe traced by the tracts that are avoided. The Chinese practicedinoculation for smallpox as early as the eleventh century.

Even the briefest sketch of the condition of Chinese medicineleaves the impression of the appalling stagnation and sterilitythat may afflict a really intelligent people for thousands ofyears. It is doubtful if they are today in a very much moreadvanced condition than were the Egyptians at the time when theEbers Papyrus was written. From one point of view it is aninteresting experiment, as illustrating the state in which apeople may remain who have no knowledge of anatomy, physiology orpathology.

Early Japanese medicine has not much to distinguish it from theChinese. At first purely theurgic, the practice was latercharacterized by acupuncture and a refined study of the pulse. Ithas an extensive literature, largely based upon the Chinese, andextending as far back as the beginning of the Christian era.European medicine was introduced by the Portuguese and the Dutch,whose "factory" or "company" physicians were not withoutinfluence upon practice. An extraordinary stimulus was given tothe belief in European medicine by a dissection made by Mayeno in1771 demonstrating the position of the organs as shown in theEuropean anatomical tables, and proving the Chinese figures to beincorrect. The next day a translation into Japanese of theanatomical work of Kulmus was begun, and from its appearance in1773 may be dated the commencement of reforms in medicine. In1793, the work of de Gorter on internal medicine was translated,and it is interesting to know that before the so-called "openingof Japan" many European works on medicine had been published. In

1857, a Dutch medical school was started in Yedo. Since thepolitical upheaval in 1868, Japan has made rapid progress inscientific medicine, and its institutions and teachers are nowamong the best known in the world.[28]

[28] See Y. Fujikawa, Geschichte der Medizin in Japan, Tokyo,1911.

CHAPTER II

GREEK MEDICINE

OGRAIAE gentis decus! let us sing with Lucretius, one of thegreat interpreters of Greek thought. How grand and how true ishis paean!

Out of the night, out of the blinding nightThy beacon flashes;--hail, beloved lightOf Greece and Grecian; hail, for in the mirkThou cost reveal each valley and each height.

Thou art my leader, and the footprints shine,Wherein I plant my own....

* * * * *

The world was shine to read, and having read,Before thy children's eyes thou didst outspreadThe fruitful page of knowledge, all the wealthOf wisdom, all her plenty for their bread.

[Bk. III.--Translated by D. A. Slater.]

Let us come out of the murky night of the East, heavy withphantoms,into the bright daylight of the West, into the company of menwhosethoughts made our thoughts, and whose ways made our ways--the menwho first dared to look on nature with the clear eyes of themind.

Browning's famous poem, "Childe Roland to the Dark Tower Came,"is an allegory of the pilgrimage of man through the dark placesof the earth, on a dismal path beset with demons, and strewn withthe wreckage of generations of failures. In his ear tolled theknell of all the lost adventurers, his peers, all lost, lostwithin sight of the dark Tower itself--

The round squat turret, blind as the fool's heart,Built of brown stone, without a counterpartIn the whole world.

lost in despair at an all-encircling mystery. Not so the GreekChilde Roland who set the slug-horn to his lips and blew a

challenge. Neither Shakespeare nor Browning tells us whathappened, and the old legend, Childe Roland, is the incarnationof the Greek spirit, the young, light-hearted master of themodern world, at whose trumpet blast the dark towers ofignorance, superstition and deceit have vanished into thin air,as the baseless fabric of a dream. Not that the jeering phantomshave flown! They still beset, in varied form, the path of eachgeneration; but the Achaian Childe Roland gave to manself-confidence, and taught him the lesson that nature'smysteries, to be solved, must be challenged. On a portal of oneof the temples of Isis in Egypt was carved: "I am whatever hathbeen, is, or ever will be, and my veil no man has yet lifted."

The veil of nature the Greek lifted and herein lies his value tous. What of this Genius? How did it arise among the peoples ofthe AEgean Sea? Those who wish to know the rock whence sciencewas hewn may read the story told in vivid language by ProfessorGomperz in his "Greek Thinkers," the fourth volume of which hasrecently been published (Murray, 1912; Scribner, 1912). In 1912,there was published a book by one of the younger Oxford teachers,"The Greek Genius and Its Meaning to Us,"[1] from which those whoshrink from the serious study of Gomperz' four volumes may learnsomething of the spirit of Greece. Let me quote a few lines fromhis introduction:

[1] By R. W. Livingstone, Clarendon Press, Oxford, 1912 [2d ed.,revised, 1915].

"Europe has nearly four million square miles; Lancashire has1,700; Attica has 700. Yet this tiny country has given us an artwhich we, with it and all that the world has done since it forour models, have equalled perhaps, but not surpassed. It hasgiven us the staple of our vocabulary in every domain of thoughtand knowledge. Politics, tyranny, democracy, anarchism,philosophy, physiology, geology, history--these are all Greekwords. It has seized and up to the present day kept hold of ourhigher education. It has exercised an unfailing fascination,even on minds alien or hostile. Rome took her culture thence.Young Romans completed their education in the Greek schools....And so it was with natures less akin to Greece than the Roman.St. Paul, a Hebrew of the Hebrews, who called the wisdom of theGreeks foolishness, was drawn to their Areopagus, and foundhimself accommodating his gospel to the style, and quoting versesfrom the poets of this alien race. After him, the Church, whichwas born to protest against Hellenism, translated its dogmas intothe language of Greek thought and finally crystallized them inthe philosophy of Aristotle."

Whether a plaything of the gods or a cog in the wheels of theuniverse this was the problem which life offered to the thinkingGreek; and in undertaking its solution, he set in motion theforces that have made our modern civilization. That the problemremains unsolved is nothing in comparison with the supreme factthat in wrestling with it, and in studying the laws of themachine, man is learning to control the small section of it withwhich he is specially concerned. The veil of thaumaturgy which

shrouded the Orient, while not removed, was rent in twain, andfor the first time in history, man had a clear vision of theworld about him--"had gazed on Nature's naked loveliness"("Adonais") unabashed and unaffrighted by the supernatural powersabout him. Not that the Greek got rid of his gods--far fromit!--but he made them so like himself, and lived on terms of suchfamiliarity with them that they inspired no terror.[2]

[2] "They made deities in their own image, in the likeness of animage of corruptible man. Sua cuique deu fit dira cupido. 'Eachman's fearful passion becomes his god.' Yes, and not passionsonly, but every impulse, every aspiration, every humour, everyvirtue, every whim. In each of his activities the Greek foundsomething wonderful, and called it God: the hearth at which hewarmed himself and cooked his food, the street in which his housestood, the horse he rode, the cattle he pastured, the wife hemarried, the child that was born to him, the plague of which hedied or from which he recovered, each suggested a deity, and hemade one to preside over each. So too with qualities and powersmore abstract." R.W. Livingstone: The Greek Genius and ItsMeaning to Us, pp. 51-52.

Livingstone discusses the Greek Genius as displayed to us incertain "notes"--the Note of Beauty--the Desire for Freedom--theNote of Directness--the Note of Humanism--the Note of Sanity andof Many-sidedness. Upon some of these characteristics we shallhave occasion to dwell in the brief sketch of the rise ofscientific medicine among this wonderful people.

We have seen that the primitive man and in the greatcivilizations of Egypt and Babylonia, the physician evolved fromthe priest--in Greece he had a dual origin, philosophy andreligion. Let us first trace the origins in the philosophers,particularly in the group known as the Ionian Physiologists,whether at home or as colonists in the south of Italy, in whosework the beginnings of scientific medicine may be found. Let mequote a statement from Gomperz:

"We can trace the springs of Greek success achieved andmaintained by the great men of Hellas on the field of scientificinquiry to a remarkable conjunction of natural gifts andconditions. There was the teeming wealth of constructiveimagination united with the sleepless critical spirit whichshrank from no test of audacity; there was the most powerfulimpulse to generalization coupled with the sharpest faculty fordescrying and distinguishing the finest shades of phenomenalpeculiarity; there was the religion of Hellas, which affordedcomplete satisfaction to the requirements of sentiment, and yetleft the intelligence free to perform its destructive work; therewere the political conditions of a number of rival centres ofintellect, of a friction of forces, excluding the possibility ofstagnation, and, finally, of an order of state and society strictenough to curb the excesses of 'children crying for the moon,'and elastic enough not to hamper the soaring flight of superiorminds.... We have already made acquaintance with two of thesources from which the spirit of criticism derived its

nourishment--the metaphysical and dialectical discussionspracticed by the Eleatic philosophers, and the semi-historicalmethod which was applied to the myths by Hecataeus and Herodotus.A third source is to be traced to the schools of the physicians.These aimed at eliminating the arbitrary element from the viewand knowledge of nature, the beginnings of which were bound upwith it in a greater or less degree, though practically withoutexception and by the force of an inner necessity. A knowledge ofmedicine was destined to correct that defect, and we shall markthe growth of its most precious fruits in the increased power ofobservation and the counterpoise it offered to hastygeneralizations, as well as in the confidence which learnt toreject untenable fictions, whether produced by luxuriantimagination or by a priori speculations, on the similar ground ofself-reliant sense-perception."[3]

[3] Gomperz: Greek Thinkers, Vol. I, p. 276.

The nature philosophers of the Ionian days did not contributemuch to medicine proper, but their spirit and their outlook uponnature influenced its students profoundly. Their boldgeneralizations on the nature of matter and of the elements arestill the wonder of chemists. We may trace to one of them,Anaximenes, who regarded air as the primary principle, thedoctrine of the "pneuma," or the breath of life--the psychicforce which animates the body and leaves it at death--"Our soulbeing air, holds us together." Of another, the famous Heraclitus,possibly a physician, the existing fragments do not relatespecially to medicine; but to the philosopher of fire may betraced the doctrine of heat and moisture, and their antitheses,which influenced practice for many centuries. There is evidencein the Hippocratic treatise peri sarkwn of an attempt to applythis doctrine to the human body. The famous expression, pantarhei,--"all things are flowing,"--expresses the incessant flux inwhich he believed and in which we know all matter exists. No onehas said a ruder thing of the profession, for an extant fragmentreads: ". . . physicians, who cut, burn, stab, and rack thesick, then complain that they do not get any adequate recompensefor it."[4]

[4] J. Burnet: Early Greek Philosophy, 1892, p. 137, Bywater'sno. LVIII.

The South Italian nature philosophers contributed much more tothe science of medicine, and in certain of the colonial townsthere were medical schools as early as the fifth century B.C. Themost famous of these physician philosophers was Pythagoras, whoselife and work had an extraordinary influence upon medicine,particularly in connection with his theory of numbers, and theimportance of critical days. His discovery of the dependence ofthe pitch of sound on the length of the vibrating chord is one ofthe most fundamental in acoustics. Among the members of theschool which he founded at Crotona were many physicians. whocarried his views far and wide throughout Magna Graecia. Nothingin his teaching dominated medicine so much as the doctrine of

numbers, the sacredness of which seems to have had an enduringfascination for the medical mind. Many of the common diseases,such as malaria, or typhus, terminating abruptly on special days,favored this belief. How dominant it became and how persistentyou may judge from the literature upon critical days, which isrich to the middle of the eighteenth century.

One member of the Crotonian school, Alcmaeon, achieved greatdistinction in both anatomy and physiology. He first recognizedthe brain as the organ of the mind, and made careful dissectionsof the nerves, which he traced to the brain. He described theoptic nerves and the Eustachian tubes, made correct observationsupon vision, and refuted the common view that the sperma camefrom the spinal cord. He suggested the definition of health asthe maintenance of equilibrium, or an "isonomy" in the materialqualities of the body. Of all the South Italian physicians ofthis period, the personality of none stands out in strongeroutlines than that of Empedocles of Agrigentum--physician,physiologist, religious teacher, politician and poet. Awonder-worker, also, and magician, he was acclaimed in the citiesas an immortal god by countless thousands desiring oracles orbegging the word of healing. That he was a keen student of natureis witnessed by many recorded observations in anatomy andphysiology; he reasoned that sensations travel by definite pathsto the brain. But our attention must be confined to hisintroduction of the theory of the four elements--fire, air, earthand water--of which, in varying quantities, all bodies were madeup. Health depended upon the due equilibrium of these primitivesubstances; disease was their disturbance. Corresponding tothose were the four essential qualities of heat and cold,moisture and dryness, and upon this four-fold division wasengrafted by the later physicians the doctrine of the humorswhich, from the days of Hippocrates almost to our own, dominatedmedicine. All sorts of magical powers were attributed toEmpedocles. The story of Pantheia whom he called back to lifeafter a thirty days' trance has long clung in the imagination.You remember how Matthew Arnold describes him in the well-knownpoem, "Empedocles on Etna"--

But his powerSwells with the swelling evil of this time,And holds men mute to see where it will rise.He could stay swift diseases in old days,Chain madmen by the music of his lyre,Cleanse to sweet airs the breath of poisonous streams,And in the mountain-chinks inter the winds.This he could do of old--[5]

a quotation which will give you an idea of some of the powersattributed to this wonder-working physician.

[5] Poetical Works of Matthew Arnold, Macmillan & Co., 1898, p.440.

But of no one of the men of this remarkable circle have we suchdefinite information as of the Crotonian physician Democedes,

whose story is given at length by Herodotus; and his story hasalso the great importance of showing that, even at this earlyperiod, a well-devised scheme of public medical service existedin the Greek cities. It dates from the second half of the sixthcentury B.C.--fully two generations before Hippocrates. ACrotonian, Democedes by name, was found among the slaves ofOroetes. Of his fame as a physician someone had heard and he wascalled in to treat the dislocated ankle of King Darius. The wilyGreek, longing for his home, feared that if he confessed to aknowledge of medicine there would be no chance of escape, butunder threat of torture he undertook a treatment which provedsuccessful. Then Herodotus tells his story--how, ill treated athome in Crotona, Democedes went to AEgina, where he set up as aphysician and in the second year the State of AEgina hired hisservices at the price of a talent. In the third year, theAthenians engaged him at 100 minae; and in the fourth, Polycratesof Samos at two talents. Democedes shared the misfortunes ofPolycrates and was taken prisoner by Oroetes. Then Herodotustells how he cured Atossa, the daughter of Cyrus and wife ofDarius, of a severe abscess of the breast, but on condition thatshe help him to escape, and she induced her husband to send anexpedition of exploration to Greece under the guidance ofDemocedes, but with the instructions at all costs to bring backthe much prized physician. From Tarentum, Democedes escaped tohis native city, but the Persians followed him, and it was withthe greatest difficulty that he escaped from their hands.Deprived of their guide, the Persians gave up the expedition andsailed for Asia. In palliation of his flight, Democedes sent amessage to Darius that he was engaged to the daughter of Milo,the wrestler, who was in high repute with the King.[6]

[6] The well-known editor of Herodotus, R. W. Macan, Master ofUniversity College, Oxford, in his Hellenikon. A Sheaf ofSonnets after Herodotus (Oxford, 1898) has included a poem whichmay be quoted in connection with this incident:

NOSTALGY Atossa, child of Cyrus king of kings, healed by Greek science of a morbid breast, gave lord Dareios neither love nor rest till he fulfilled her vain imaginings. "Sir, show our Persian folk your sceptre's wings! Enlarge my sire's and brother's large bequest. This learned Greek shall guide your galleys west, and Dorian slave-girls grace our banquetings." So said she, taught of that o'er-artful man, the Italiote captive, Kroton's Demokede, who recked not what of maladies began, nor who in Asia and in Greece might bleed, if he--so writes the guileless Thurian-- regained his home, and freedom of the Mede.

Plato has several references to these state physicians, who wereevidently elected by a public assembly: "When the assembly meetsto elect a physician," and the office was yearly, for in "The

Statesman" we find the following:[7] "When the year of office hasexpired, the pilot, or physician has to come before a court ofreview" to answer any charges. The physician must have been inpractice for some time and attained eminence, before he wasdeemed worthy of the post of state physician.

[7] Jowett: Dialogues of Plato, 3d ed., Statesman, Vol. IV, p.502 (Stephanus, II, 298 E)

"If you and I were physicians, and were advising one another thatwe were competent to practice as state-physicians, should I notask about you, and would you not ask about me, Well, but howabout Socrates himself, has he good health? and was anyone elseever known to be cured by him whether slave or freeman?"[7a]

[7a] Jowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II, p.407 (Stephanus, I, 514 D).

All that is known of these state physicians has been collected byPohl,[8] who has traced their evolution into Roman times. Thatthey were secular, independent of the AEsculapian temples, thatthey were well paid, that there was keen competition to get themost distinguished men, that they were paid by a special tax andthat they were much esteemed-- are facts to be gleaned fromHerodotus and from the inscriptions. The lapidary records,extending over 1000 years, collected by Professor Oehler[8a] ofReina, throw an important light on the state of medicine inGreece and Rome. Greek vases give representations of these statedoctors at work. Dr. E. Pottier has published one showing thetreatment of a patient in the clinic.[8b]

[8] R. Pohl: De Graecorum medicis publicis, Berolini, Reimer,1905; also Janus, Harlem, 1905, X, 491-494.

[8a] J Oehler: Janus, Harlem, 1909, XIV, 4; 111.

[8b] E. Pottier: Une clinique grecque au Ve siecle, Monuments etMemoires, XIII, p. 149. Paris, 1906 (Fondation Eugene Piot).

That dissections were practiced by this group of naturephilosophers is shown not only by the studies of Alcmaeon, but wehave evidence that one of the latest of them, Diogenes ofApollonia, must have made elaborate dissections. In the "HistoriaAnimalium"[9] of Aristotle occurs his account of the bloodvessels, which is by far the most elaborate met with in theliterature until the writings of Galen. It has, too, the greatmerit of accuracy (if we bear in mind the fact that it was notuntil after Aristotle that arteries and veins weredifferentiated), and indications are given as to the vessels fromwhich blood may be drawn.

[9] The Works of Aristotle, Oxford, Clarendon Press, Vol. IV,1910, Bk. III, Chaps. II-IV, pp. 511b-515b.

ASKLEPIOS

No god made with hands, to use the scriptural phrase, had a moresuccessful "run" than Asklepios--for more than a thousand yearsthe consoler and healer of the sons of men. Shorn of his divineattributes he remains our patron saint, our emblematic God ofHealing, whose figure with the serpents appears in our seals andcharters. He was originally a Thessalian chieftain, whose sons,Machaon and Podalirius, became famous physicians and fought inthe Trojan War. Nestor, you may remember, carried off theformer, declaring, in the oft-quoted phrase, that a doctor wasbetter worth saving than many warriors unskilled in the treatmentof wounds. Later genealogies trace his origin to Apollo,[10] aswhose son he is usually regarded. "In the wake of northern tribesthis god Aesculapius--a more majestic figure than the blamelessleech of Homer's song--came by land to Epidaurus and was carriedby sea to the east-ward island of Cos.... Aesculapius grew inimportance with the growth of Greece, but may not have attainedhis greatest power until Greece and Rome were one."[11]

[10] W. H. Roscher: Lexikon der griechischen und romischenMythologie, Leipzig, 1886, I, p. 624.

[11] Louis Dyer: Studies of the Gods in Greece, 1891, p. 221.

A word on the idea of the serpent as an emblem of the healing artwhich goes far back into antiquity. The mystical character ofthe snake, and the natural dread and awe inspired by it, earlymade it a symbol of supernatural power. There is a libation vaseof Gudea, c. 2350 B.C., found at Telloh, now in the Louvre(probably the earliest representation of the symbol), with twoserpents entwined round a staff (Jastrow, Pl. 4). From theearliest times the snake has been associated with mystic andmagic power, and even today, among native races, it plays a partin the initiation of medicine men.

In Greece, the serpent became a symbol of Apollo, and propheticserpents were kept and fed at his shrine, as well as at that ofhis son, Asklepios. There was an idea, too, that snakes had aknowledge of herbs, which is referred to in the famous poem ofNikander on Theriaka.[12] You may remember that when Alexander,the famous quack and oracle monger, depicted by Lucian, startedout "for revenue," the first thing he did was to provide himselfwith two of the large, harmless, yellow snakes of Asia Minor.

[12] Lines 31, etc., and Scholia; cf. W. R. Halliday: GreekDivination, London, 1913, p. 88.

The exact date of the introduction of the cult into Greece is notknown, but its great centres were at Epidaurus, Cos, Pergamos andTricca. It throve with wonderful rapidity. Asklepios became oneof the most popular of the gods. By the time of Alexander it isestimated that there were between three and four hundred templesdedicated to him.

His worship was introduced into Rome at the time of the GreatPlague at the beginning of the third century B.C. (as told byLivy in Book XI), and the temple on the island of Tiber became afamous resort. If you can transfer in imagination the Hot Springsof Virginia to the neighborhood of Washington, and put there agroup of buildings such as are represented in these outlines ofCaton's[13] (p. 52), add a sumptuous theatre with seatingcapacity for 20,000, a stadium 600 feet long with a seatingcapacity of 12,000, and all possible accessories of art andscience, you will have an idea of what the temple at Epidaurus, afew miles from Athens, was. "The cult flourished mostly inplaces which, through climatic or hygienic advantages, werenatural health resorts. Those favoured spots on hill or mountain,in the shelter of forests, by rivers or springs of pure flowingwater, were conducive to health. The vivifying air, the wellcultivated gardens surrounding the shrine, the magnificent view,all tended to cheer the heart with new hope of cure. Many ofthese temples owed their fame to mineral or merely hot springs.To the homely altars, erected originally by sacred fountains inthe neighbourhood of health-giving mineral springs, were lateradded magnificent temples, pleasure-grounds for festivals,gymnasia in which bodily ailments were treated by physicalexercises, baths and inunctions, also, as is proved byexcavations, living rooms for the patients. Access to the shrinewas forbidden to the unclean and the impure, pregnant women andthe mortally afflicted were kept away; no dead body could find aresting-place within the holy precincts, the shelter and the cureof the sick being undertaken by the keepers of inns andboarding-houses in the neighbourhood. The suppliants for aid hadto submit to careful purification, to bathe in sea, river orspring, to fast for a prescribed time, to abjure wine and certainarticles of diet, and they were only permitted to enter thetemple when they were adequately prepared by cleansing, inunctionand fumigation. This lengthy and exhausting preparation, partlydietetic, partly suggestive, was accompanied by a solemn serviceof prayer and sacrifice, whose symbolism tended highly to excitethe imagination."[14]

[13] Caton: Temples and Ritual of Asklepios, 2d ed., London,1900.

[14] Max Neuburger: History of Medicine, English translation,Oxford, 1910, p. 94.

The temples were in charge of members of the guild or fraternity,the head of which was often, though not necessarily, a physician.The Chief was appointed annually. From Caton's excellentsketch[15] you can get a good idea of the ritual, but stillbetter is the delightful description given in the "Plutus" ofAristophanes. After offering honey-cakes and baked meats on thealtar, the suppliants arranged themselves on the pallets.

[15] Caton: Temples and Ritual of Asklepios, 2d ed., London,1900.

Soon the Temple servitorPut out the lights and bade us fall asleep,Nor stir, nor speak, whatever noise we heard.So down we lay in orderly repose.And I could catch no slumber, not one wink,Struck by a nice tureen of broth which stoodA little distance from an old wife's head,Whereto I marvellously longed to creep.Then, glancing upwards, I beheld the priestWhipping the cheese-cakes and figs from offThe holy table; thence he coasted roundTo every altar spying what was left.And everything he found he consecratedInto a sort of sack--[16]

a procedure which reminds one of the story of "Bel and theDragon." Then the god came, in the person of the priest, andscanned each patient. He did not neglect physical measures, as hebrayed in a mortar cloves, Tenian garlic, verjuice, squills andSphettian vinegar, with which he made application to the eyes ofthe patient.

[16] Aristophanes: B. B. Roger's translation, London, Bell &Sons, 1907, Vol. VI, ll. 668, etc., 732 ff.

Then the God clucked,And out there issued from the holy shrineTwo great, enormous serpents....And underneath the scarlet cloth they crept,And licked his eyelids, as it seemed to me;And, mistress dear, before you could have drunkOf wine ten goblets, Wealth arose and saw.[17]

[17] Ibid.

The incubation sleep, in which indications of cure were divinelysent, formed an important part of the ritual.

The Asklepieion, or Health Temple of Cos, recently excavated, isof special interest, as being at the birthplace of Hippocrates,who was himself an Asklepiad. It is known that Cos was a greatmedical school. The investigations of Professor Rudolf Hertzoghave shown that this temple was very nearly the counterpart ofthe temple at Epidaurus.

The AEsculapian temples may have furnished a rare field forempirical enquiry. As with our modern hospitals, the largertemple had rich libraries, full of valuable manuscripts andrecords of cases. That there may have been secular Asklepiadsconnected with the temple, who were freed entirely from itssuperstitious practices and theurgic rites, is regarded asdoubtful; yet is perhaps not so doubtful as one might think. Howoften have we physicians to bow ourselves in the house of Rimmon!It is very much the same today at Lourdes, where lay physicianshave to look after scores of patients whose faith is too weak or

whose maladies are too strong to be relieved by Our Lady of thisfamous shrine. Even in the Christian era, there is evidence ofthe association of distinguished physicians with AEsculapiantemples. I notice that in one of his anatomical treatises, Galenspeaks with affection of a citizen of Pergamos who has been agreat benefactor of the AEsculapian temple of that city. In"Marius, the Epicurean," Pater gives a delightful sketch of oneof those temple health resorts, and brings in Galen, stating thathe had himself undergone the temple sleep; but to this I can findno reference in the general index of Galen's works.

From the votive tablets found at Epidaurus, we get a very goodidea of the nature of the cases and of the cures. A large numberof them have now been deciphered. There are evidences of variousforms of diseases of the joints, affections of women, wounds,baldness, gout; but we are again in the world of miracles, as youmay judge from the following: "Heraicus of Mytilene is bald andentreats the God to make his hair grow. An ointment is appliedover night and the next morning he has a thick crop of hair."

There are indications that operations were performed andabscesses opened. From one we gather that dropsy was treated in anovel way: Asklepios cuts off the patient's head, holds him up bythe heels, lets the water run out, claps on the patient's headagain. Here is one of the invocations: "Oh, blessed Asklepios,God of Healing, it is thanks to thy skill that Diophantes hopesto be relieved from his incurable and horrible gout, no longer tomove like a crab, no longer to walk upon thorns, but to havesound feet as thou hast decreed."

The priests did not neglect the natural means of healing. Theinscriptions show that great attention was paid to diet,exercise, massage and bathing, and that when necessary, drugswere used. Birth and death were believed to defile the sacredprecincts, and it was not until the time of the Antonines thatprovision was made at Epidaurus for these contingencies.

One practice of the temple was of special interest, viz., theincubation sleep, in which dreams were suggested to the patients.In the religion of Babylonia, an important part was played by themystery of sleep, and the interpretation of dreams; and no doubtfrom the East the Greeks took over the practice of divination insleep, for in the AEsculapian cult also, the incubation sleepplayed a most important role. That it continued in later times iswell indicated in the orations of Aristides, thearch-neurasthenic of ancient history, who was a great dreamer ofdreams. The oracle of Amphiaraus in Attica sent dreams into thehearts of his consultants. "The priests take the inquirer, andkeep him fasting from food for one day, and from wine for threedays, to give him perfect spiritual lucidity to absorb the divinecommunication" (Phillimore's "Apollonius of Tyana," Bk. II, Ch.XXXVII). How incubation sleep was carried into the ChristianChurch, its association with St. Cosmas and St. Damian and othersaints, its practice throughout the Middle Ages, and itscontinuation to our own time may be read in the careful study ofthe subject made by Miss Hamilton (now Mrs. Dickens).[18] Thereare still in parts of Greece and in Asia Minor shrines at which

incubation is practiced regularly, and if one may judge from thereports, with as great success as in Epidaurus. At one place inBritain, Christchurch in Monmouthshire, incubation was carried ontill the early part of the nineteenth century. Now the professionhas come back to the study of dreams,[19] and there areprofessors as ready to give suggestive interpretations to them,as in the days of Aristides. As usual, Aristotle seems to havesaid the last word on the subject: "Even scientific physicianstell us that one should pay diligent attention to dreams, and tohold this view is reasonable also for those who are notpractitioners but speculative philosophers,"[20] but it is askingtoo much to think that the Deity would trouble to send dreams tovery simple people and to animals, if they were designed in anyway to reveal the future.

In its struggle with Christianity, Paganism made its last standin the temples of Asklepios. The miraculous healing of thesaints superseded the cures of the heathen god, and it was wiseto adopt the useful practice of his temple.

[18] Mary Hamilton: Incubation, or the Cure of Disease in PaganTemples and Christian Churches, London, 1906.

[19] Freud: The Interpretation of Dreams, translation of thirdedition by A. A. Brill, 1913.

[20] Aristotle: Parva Naturalia, De divinatione per somnium, Ch.I, Oxford ed., Vol. III, 463 a.

HIPPOCRATES AND THE HIPPOCRATIC WRITINGS

DESERVEDLY the foundation of Greek Medicine is associated withthe name of Hippocrates, a native of the island of Cos; and yethe is a shadowy personality, about whom we have little accuratefirst-hand information. This is in strong contrast to some ofhis distinguished contemporaries and successors, for example,Plato and Aristotle, about whom we have such full and accurateknowledge. You will, perhaps, be surprised to hear that the onlycontemporary mention of Hippocrates is made by Plato. In the"Protagoras," the young Hippocrates, son of Apollodorus has cometo Protagoras, "that mighty wise man," to learn the science andknowledge of human life. Socrates asked him: "If . . . you hadthought of going to Hippocrates of Cos, the Asclepiad, and wereabout to give him your money, and some one had said to you, 'Youare paying money to your namesake Hippocrates, O Hippocrates;tell me, what is he that you give him money?' how would you haveanswered?" "I should say," he replied, "that I gave money to himas a physician." "And what will he make of you?" "A physician,"he said. And in the Phaedrus, in reply to a question of Socrateswhether the nature of the soul could be known intelligentlywithout knowing the nature of the whole, Phaedrus replies:"Hippocrates, the Asclepiad, says that the nature, even of thebody, can only be understood as a whole." (Plato, I, 311; III,270--Jowett, I, 131, 479.)

Several lives of Hippocrates have been written. The one most

frequently quoted is that of Soranus of Ephesus (not the famousphysician of the time of Trajan), and the statements which hegives are usually accepted, viz., that he was born in the islandof Cos in the year 460 B.C.; that he belonged to an Asklepiadfamily of distinction, that he travelled extensively, visitingThrace, Thessaly, and various other parts of Greece; that hereturned to Cos, where he became the most renowned physician ofhis period, and died about 375 B.C. Aristotle mentions him butonce, calling him "the great Hippocrates." Busts of him arecommon; one of the earliest of which, and I am told the best,dating from Roman days and now in the British Museum, is hererepresented.

Of the numerous writings attributed to Hippocrates it cannoteasily be determined which are really the work of the Father ofMedicine himself. They were collected at the time of theAlexandrian School, and it became customary to write commentariesupon them; much of the most important information we have aboutthem, we derive from Galen. The earliest manuscript is the"Codex Laurentianus" of Florence, dating from the ninth century,a specimen page of which (thanks to Commendatore Biagi) isannexed. Those of you who are interested, and wish to have fullreferences to the various works attributed to Hippocrates, willfind them in "Die Handschriften der antiken Aerzte" of thePrussian Academy, edited by Diels (Berlin, 1905). The PrussianAcademy has undertaken the editorship of the "Corpus MedicorumGraecorum." There is no complete edition of them in English. In1849 the Deeside physician, Adams, published (for the OldSydenham Society) a translation of the most important works, avaluable edition and easily obtained. Littre's ten-volumeedition OEuvres completes d'Hippocrate," Paris, 1839-1861, is themost important for reference. Those of you who want a brief butvery satisfactory account of the Hippocratic writings, withnumerous extracts,will find the volume of Theodor Beck (Jena,1907) very useful.

I can only indicate, in a very brief way, the special features ofthe Hippocratic writings that have influenced the evolution ofthe science and art of medicine.

The first is undoubtedly the note of humanity. In hisintroduction to, "The Rise of the Greek Epic,"[21] Gilbert Murrayemphasizes the idea of service to the community as more deeplyrooted in the Greeks than in us. The question they asked abouteach writer was, "Does he help to make better men?" or "Does hemake life a better thing?"Their aim was to be useful, to behelpful, to make better men in the cities, to correct life, "tomake gentle the life of the world." In this brief phrase weresummed up the aspirations of the Athenians, likewise illuminatedin that remarkable saying of Prodicus (fifth century B.C.), "Thatwhich benefits human life is God." The Greek view of man was thevery antithesis of that which St. Paul enforced upon theChristian world. One idea pervades thought from Homer toLucian-like an aroma-- pride in the body as a whole. In thestrong conviction that "our soul in its rose mesh" is quite asmuch helped by flesh as flesh by the soul the Greek sang hissong--"For pleasant is this flesh."Just so far as we appreciate

the value of the fair mind in the fair body,so far do weapprehend ideals expressed by the Greek in every department oflife. The beautiful soul harmonizing with the beautiful body wasas much the glorious ideal of Plato as it was the end of theeducation of Aristotle. What a splendid picture in Book III ofthe"Republic," of the day when ". . . our youth will dwell in aland of health, amid fair sights and sounds and receive the goodin everything;and beauty, the effluence of fair works, shall flowinto the eye and ear like a health-giving breeze from a purerregion, and insensibly draw the soul from earliest years intolikeness and sympathy with the beauty of reason." The glory ofthis zeal for the enrichment of this present life was revealed tothe Greeks as to no other people, but in respect to care for thebody of the common man, we have only seen its fulfilment in ourown day, as a direct result of the methods of research initiatedby them. Everywhere throughout the Hippocratic writings we findthis attitude towards life, which has never been better expressedthan in the fine phrase, "Where there is love of humanity therewill be love of the profession." This is well brought out in thequalifications laid down by Hippocrates for the study ofmedicine."Whoever is to acquire a competent knowledge of medicineought to be possessed of the following advantages: a naturaldisposition; instruction;a favourable position for the study;early tuition; love of labour; leisure. First of all, a naturaltalent is required, for when nature opposes, everything else isvain; but when nature leads the way to what is most excellent,instruction in the art takes place, which the student must try toappropriate to himself by reflection, becoming a nearly pupil ina place well adapted for instruction. He must also bring to thetask a love of labour and perseverance, so that the instructiontaking root may bring forth proper and abundant fruits." And thedirections given for the conduct of life and for the relationwhich the physician should have with the public are those of ourcode of ethics today. Consultations in doubtful cases areadvised, touting for fees is discouraged. "If two or more ways ofmedical treatment were possible, the physician was recommended tochoose the least imposing or sensational; it was an act of'deceit' to dazzle the patient's eye by brilliant exhibitions ofskill which might very well be dispensed with. The practice ofholding public lectures in order to increase his reputation wasdiscouraged in the physician, and he was especially warnedagainst lectures tricked out with quotations from the poets.Physicians who pretended to infallibility in detecting even theminutest departure from their prescriptions were laughed at; andfinally, there were precise by-laws to regulate the personalbehaviour of the physician. He was enjoined to observe the mostscrupulous cleanliness, and was advised to cultivate an eleganceremoved from all signs of luxury, even down to the detail that hemight use perfumes,but not in an immoderate degree."[22] But thehigh-water mark of professional morality is reached in the famousHippocratic oath,which Gomperz calls "a monument of the highestrank in the history of civilization." It is of small matterwhether this is of Hippocratic date or not, or whether it has init Egyptian or Indian elements: its importance lies in theaccuracy with which it represents the Greek spirit. Fortwenty-five centuries it has been the "credo" of the profession,and in many universities it is still the formula with which men

are admitted to the doctorate.

[21] Oxford. Clarendon Press, 2d ed., 1911.

[22] Gomperz: Greek Thinkers, Vol. I, p. 281.

I swear by Apollo the physician and AEsculapius and Health(Hygieia) and All-Heal (Panacea) and all the gods and goddesses,that, according to my ability and judgment, I will keep this oathand this stipulation--to reckon him who taught me this artequally dear to me as my parents, to share my substance with him,and relieve his necessities if required; to look upon hisoffspring in the same footing as my own brothers, and to teachthem this art,if they shall wish to learn it, without fee orstipulation; and that by precept,lecture, and every other mode ofinstruction, I will impart a knowledge of my art to my own sons,and those of my teachers, and to disciples bound by a stipulationand oath according to the law of medicine, but to none others. Iwill follow that system of regimen which, according to my abilityand judgement,I consider for the benefit of my patients, andabstain from whatever is deleterious and mischievous.

I will give no deadly medicine to anyone if asked, nor suggestany such counsel; and in like manner I will not give to a woman apessary to produce abortion.

With purity and with holiness I will pass my life and practice myart.

[I will not cut persons labouring under the stone, but will leavethis to be done by men who are practitioners of this work.]

Into whatsoever houses I enter, I will go into them for thebenefit of the sick, and will abstain from every voluntary act ofmischief and corruption, and,further, from the abduction offemales or males, of freemen and slaves. Whatever, in connectionwith my professional practice, or not in connection with it,I seeor hear, in the life of men, which ought not to be spoken ofabroad, I will not divulge, as reckoning that all such should bekept secret.

While I continue to keep this Oath unviolated, may it be grantedto me to enjoy life and the practice of the art, respected by allmen, in all times! But should I trespass and violate this Oath,may the reverse be my lot!

(Adams, II, 779, cf. Littre, IV, 628.)

In his ideal republic, Plato put the physician low enough, in thelast stratum, indeed, but he has never been more honorably placedthan in the picture of Athenian society given by this author inthe "Symposium." Here the physician is shown as a cultivatedgentleman, mixing in the best, if not always the most sober,society. Eryximachus, the son of Acumenus, himself a physician,plays in this famous scene a typical Greek part[22a]--a strong

advocate of temperance in mind and body, deprecating, as aphysician, excess in drink, he urged that conversation should bethe order of the day and he had the honor of naming thesubject--"Praise of the God of Love." Incidentally Eryximachusgives his view of the nature of disease, and shows how deeply hewas influenced by the views of Empedocles:". . . so too in thebody the good and healthy elements are to be indulged, and thebad elements and the elements of disease are not to be indulged,but discouraged. And this is what the physician has to do, andin this the art of medicine consists: for medicine may beregarded generally as the knowledge of the loves and desires ofthe body and how to satisfy them or not; and the best physicianis he who is able to separate fair love from foul, or to convertone into the other; and he who knows how to eradicate and how toimplant love, whichever is required, and can reconcile the mosthostile elements in the constitution and make them lovingfriends, is a skilful practitioner."

[22a] Professor Gildersleeve's view of Eryximachus is lessfavorable (Johns Hopkins University Circular, Baltimore, January,1887). Plato, III, 186--Jowett, I, 556.

The second great note in Greek medicine illustrates thedirectness with which they went to the very heart of the matter.Out of mysticism, superstition and religious ritual the Greekwent directly to nature and was the first to grasp the conceptionof medicine as an art based on accurate observation, and anintegral part of the science of man. What could be more strikingthan the phrase in "The Law," "There are, in effect, two things,to know and to believe one knows; to know is science; to believeone knows is ignorance"?[23] But no single phrase in the writingscan compare for directness with the famous aphorism which hasgone into the literature of all lands: "Life is short and Art islong; the Occasion fleeting, Experience fallacious, and Judgmentdifficult."

[23] Littre: OEuvres d'Hippocrate, Vol. IV, pp. 641-642.

Everywhere one finds a strong, clear common sense, which refusesto be entangled either in theological or philosophicalspeculations. What Socrates did for philosophy Hippocrates may besaid to have done for medicine. As Socrates devoted himself toethics, and the application of right thinking to good conduct, soHippocrates insisted upon the practical nature of the art, and inplacing its highest good in the benefit of the patient.Empiricism, experience, the collection of facts, the evidence ofthe senses, the avoidance of philosophical speculations, were thedistinguishing features of Hippocratic medicine. One of the moststriking contributions of Hippocrates is the recognition thatdiseases are only part of the processes of nature, that there isnothing divine or sacred about them. With reference toepilepsy,which was regarded as a sacred disease, he says, "Itappears to me to be no wise more divine nor more sacred thanother diseases, but has a natural cause from which it originateslike other affections; men regard its nature and cause as divinefrom ignorance." And in another place he remarks that each

disease has its own nature, and that no one arises without anatural cause. He seems to have been the first to grasp theconception of the great healing powers of nature. In his longexperience with the cures in the temples, he must have seenscores of instances in which the god had worked the miraclethrough the vis medicatrix naturae; and to the shrewd wisdom ofhis practical suggestions in treatment may be attributed in largepart the extraordinary vogue which the great Coan has enjoyed fortwenty-five centuries. One may appreciate the veneration withwhich the Father of Medicine was regarded by the attribute"divine" which was usually attached to his name. Listen to thisfor directness and honesty of speech taken from the work on thejoints characterized by Littre as "the great surgical monument ofantiquity": "I have written this down deliberately, believing itis valuable to learn of unsuccessful experiments, and to know thecauses of their non-success."

The note of freedom is not less remarkable throughout theHippocratic writings, and it is not easy to understand how a manbrought up and practicing within the precincts of a famousAEsculapian temple could have divorced himself so wholly from thesuperstitions and vagaries of the cult. There are probablygrounds for Pliny's suggestion that he benefited by the receiptswritten in the temple, registered by the sick cured of anydisease. "Afterwards," Pliny goes on to remark in hischaracteristic way, "hee professed that course of Physicke whichis called Clinice Wherby physicians found such sweetnesse thatafterwards there was no measure nor end of fees" ("NaturalHistory," XXIX, 1). There is no reference in the Hippocraticwritings to divination; incubation sleep is not often mentioned,and charms, incantations or the practice of astrology but rarely.Here and there we do find practices which jar upon modernfeeling, but on the whole we feel in reading the Hippocraticwritings nearer to their spirit than to that of the Arabians orof the many writers of the fifteenth and sixteenth centuries A.D. And it is not only against the thaumaturgic powers that theHippocratic writings protested, but they express an equallyactive reaction against the excesses and defects of the newphilosophy, a point brought out very clearly by Gomperz.[24] Heregards it as an undying glory of the school of Cos that afteryears of vague, restless speculation it introduces steadysedentary habits into the intellectual life of mankind. "'Fiction to the right! Reality to the left!' was the battle-cryof this school in the war they were the first to wage against theexcesses and defects of the nature-philosophy. "Though theprotest was effective in certain directions, we shall see thatthe authors of the Hippocratic writings could not entirely escapefrom the hypotheses of the older philosophers.

[24] Gomperz: Greek Thinkers, Vol. I, p. 296.

I can do no more than indicate in the briefest possible way someof the more important views ascribed to Hippocrates. We cannottouch upon the disputes between the Coan and Cnidian schools.[25]You must bear in mind that the Greeks at this time had no humananatomy. Dissections were impossible; their physiology was of thecrudest character, strongly dominated by the philosophies.

Empedocles regarded the four elements, fire, air, earth andwater, as "the roots of all things," and this became the cornerstone in the humoral pathology of Hippocrates. As in theMacrocosm-- the world at large there were four elements, fire,air, earth, and water, so in the Microcosm--the world of man'sbody--there were four humors (elements), viz.,blood, phlegm,yellow bile (or choler) and black bile (or melancholy),and theycorresponded to the four qualities of matter, heat, cold, drynessand moisture. For more than two thousand years these viewsprevailed. In his "Regiment of Life" (1546) Thomas Phaer says:".. . which humours are called ye sones of the Elements becausethey be complexioned like the foure Elements, for like as theAyre is hot and moyst: so is the blooud, hote and moyste. And asFyer is hote and dry: so is Cholere hote and dry. And as wateris colde and moyst:so is fleume colde and moyste. And as theEarth is colde and dry: so Melancholy is colde and dry."[26]

[25] The student who wishes a fuller account is referred to thehistories of (a) Neuburger, Vol. 1, Oxford, 1910; (b) Withington,London, 1894.

[26] Thomas Phaer: Regiment of Life, London, 1546.

As the famous Regimen Sanitatis of Salernum, the popular familyhand-book of the Middle Ages, says:

Foure Humours raigne within our bodies wholly,And these compared to foure elements.[27]

[27] The Englishman's Doctor, or the Schoole of Salerne, Sir JohnHarington's translation, London, 1608, p. 2. Edited by FrancisR. Packard, New York, 1920, p. 132. Harington's book originallyappeared dated: London 1607. (Hoe copy in the Henry E.Huntington Library.)

According to Littre, there is nowhere so strong a statement ofthese views in the genuine works of Hippocrates, but they arefound at large in the Hippocratic writings, and nothing can beclearer than the following statement from the work "The Nature ofMan": "The body of man contains in itself blood and phlegm andyellow bile and black bile, which things are in the naturalconstitution of his body, and the cause of sickness and ofhealth. He is healthy when they are in proper proportion betweenone another as regards mixture and force and quantity, and whenthey are well mingled together; he becomes sick when one of theseis diminished or increased in amount, or is separated in the bodyfrom its proper mixture, and not properly mingled with all theothers." No words could more clearly express the views ofdisease which, as I mentioned, prevailed until quite recentyears. The black bile, melancholy, has given us a great word inthe language, and that we have not yet escaped from the humoralpathology of Hippocrates is witnessed by the common expression ofbiliousness--"too much bile"-- or "he has a touch of the liver."The humors, imperfectly mingled, prove irritant in the body.They are kept in due proportion by the innate heat which, by a

sort of internal coction gradually changes the humors to theirproper proportion. Whatever may be the primary cause of thechange in the humors manifesting itself in disease, the innateheat, or as Hippocrates terms it, the nature of the body itself,tends to restore conditions to the norm; and this changeoccurring suddenly, or abruptly, he calls the "crisis," which isaccomplished on some special day of the disease, and is oftenaccompanied by a critical discharge, or by a drop in the bodytemperature. The evil, or superabundant, humors were dischargedand this view of a special materies morbi, to be got rid of by anatural processor a crisis, dominated pathology until quiterecently. Hippocrates had a great belief in the power of nature,the vis medicatrix naturae, to restore the normal state. A keenobserver and an active practitioner, his views of disease, thushastily sketched, dominated the profession for twenty-fivecenturies; indeed, echoes of his theories are still heard in theschools, and his very words are daily on our lips. If asked whatwas the great contribution to medicine of Hippocrates and hisschool we could answer--the art of careful observation.

In the Hippocratic writings is summed up the experience of Greeceto the Golden Age of Pericles. Out of philosophy, out ofabstract speculation, had come a way of looking at nature forwhich the physicians were mainly responsible, and which haschanged forever men's views on disease. Medicine broke itsleading strings to religion and philosophy--a tottering, thoughlusty, child whose fortunes we are to follow in these lectures. Ihave a feeling that, could we know more of the medical history ofthe older races of which I spoke in the first lecture, we mightfind that this was not the first-born of Asklepios,that there hadbeen many premature births, many still-born offspring, evenlive-births-- the products of the fertilization of nature by thehuman mind; but the record is dark, and the infant was cast outlike Israel in the chapter of Isaiah. But the high-water mark ofmental achievement had not been reached by the great generationin which Hippocrates had labored. Socrates had been dead sixteenyears, and Plato was a man of forty-five, when far away in thenorth in the little town of Stagira, on the peninsula of MountAthos in Macedoniawas, in 384 B.C., born a "man of men," the oneabove all others to whom the phrase of Milton may be applied. Thechild of an Asklepiad, Nicomachus, physician to the father ofPhilip, there must have been a rare conjunction of the planets atthe birth of the great Stagirite. In the first circle of the"Inferno," Virgil leads Dante into a wonderful company,"star-seated" on the verdure (he says)--the philosophic familylooking with reverence on "the Master of those who know"--ilmaestro di color che sanno.[28] And with justice has Aristotlebeen so regarded for these twenty-three centuries. No man hasever swayed such an intellectual empire--in logic, metaphysics,rhetoric, psychology, ethics, poetry, politics and naturalhistory, in all a creator, and in all still a master. The historyof the human mind--offers no parallel to his career. As thecreator of the sciences of comparative anatomy, systematiczoology, embryology, teratology, botany and physiology, hiswritings have an eternal interest. They present an extraordinaryaccumulation of facts relating to the structure and functions ofvarious parts of the body. It is an unceasing wonder how one man,

even with a school of devoted students, could have done so much.

[28] The "Good collector of qualities," Dioscorides, Hippocrates,Avicenna, Galen and Averroes were the medical members of thegroup. Dante, Inferno, canto iv.

Dissection--already practiced by Alcmaeon, Democritus, Diogenesand others--was conducted on a large scale, but the human bodywas still taboo. Aristotle confesses that the "inward parts ofman are known least of all," and he had never seen the humankidneys or uterus. In his physiology, I can refer to but onepoint--the pivotal question of the heart and blood vessels. ToAristotle the heart was the central organ controlling thecirculation, the seat of vitality, the source of the blood, theplace in which it received its final elaboration and impregnationwith animal heat. The blood was contained in the heart andvessels as in a vase--hence the use of the term "vessel." "Fromthe heart the blood-vessels extend throughout the body as in theanatomical diagrams which are represented on the walls, for theparts lie round these because they are formed out of them."[29]The nutriment oozes through the blood vessels and the passages ineach of the parts "like water in unbaked pottery." He did notrecognize any distinction between arteries and veins, callingboth plebes (Littre); the vena cave is the great vessel, and theaorta the smaller; but both contain blood. He did not use theword "arteria" (arthria) for either of them. There was nomovement from the heart to the vessels but the blood wasincessantly drawn upon by the substance of the body and asunceasingly renewed by absorption of the products ofdigestion,the mesenteric vessels taking up nutriment very much asthe plants take theirs by the roots from the soil. From the lungswas absorbed the pneuma, or spiritus, which was conveyed to theheart by the pulmonary vessels--one to the right, and one to theleft side. These vessels in the lungs, "through mutual contact"with the branches of the trachea, took in the pneuma. A point ofinterest is that the windpipe,or trachea, is called "arteria,"both by Aristotle and by Hippocrates ("Anatomy," Littre, VIII,539). It was the air-tube, disseminating the breath through thelungs. We shall see in a few minutes how the term came to beapplied to the arteries, as we know them. The pulsation of theheart and arteries was regarded by Aristotle as a sort ofebullition in which the liquids were inflated by the vital orinnate heat, the fires of which were cooled by the pneuma takenin by the lungs and carried to the heart by the pulmonaryvessels.

[29] De Generatione Animalium, Oxford translation, Bk. II, Chap.6, Works V, 743 a.

In Vol. IV of Gomperz' "Greek Thinkers," you will find anadmirable discussion on Aristotle as an investigator of nature,and those of you who wish to study his natural history works moreclosely may do so easily--in the new translation which is inprocess of publication by the Clarendon Press, Oxford. At theend of the chapter "De Respiratione"in the "Parva Naturalia"

(Oxford edition, 1908), we have Aristotle's attitude towardsmedicine expressed in a way worthy of a son of the profession:

"But health and disease also claim the attention of thescientist, and not merely of the physician, in so far as anaccount of their causes is concerned. The extent to which thesetwo differ and investigate diverse provinces must not escape us,since facts show that their inquiries are, at least to a certainextent, conterminous. For physicians of culture and refinementmake some mention of natural science,and claim to derive theirprinciples from it, while the most accomplished investigatorsinto nature generally push their studies so far as to concludewith an account of medical principles." (Works, III,480 b.)

Theophrastus, a student of Aristotle and his successor, createdthe science of botany and made possible the pharmacologists of afew centuries later. Some of you doubtless know him in anotherguise--as the author of the golden booklet on "Characters," inwhich "the most eminent botanist of antiquity observes the doingsof men with the keen and unerring vision of a natural historian"(Gomperz). In the Hippocratic writings, there are mentioned 236plants; in the botany of Theophrastus, 455. To one trait ofmaster and pupil I must refer--the human feeling, not alone ofman for man, but a sympathy that even claims kinship with theanimal world. "The spirit with which he (Theophrastus) regardedthe animal world found no second expression till the present age"(Gomperz). Halliday, however,makes the statement thatPorphyry[30] goes as far as any modern humanitarian in preachingour duty towards animals.

[30] W. R. Halliday: Greek Divination, London, Macmillan & Co.,1913.

ALEXANDRIAN SCHOOL

FROM the death of Hippocrates about the year 375 B.C. till thefounding of the Alexandrian School, the physicians were engrossedlargely in speculative views, and not much real progress wasmade, except in the matter of elaborating the humoral pathology.Only three or four men of the first rank stand out in thisperiod: Diocles the Carystian, "both in time and reputation nextand second to Hippocrates" (Pliny), a keen anatomist and anencyclopaedic writer; but only scanty fragments of his workremain. In some ways the most important member of this group wasPraxagoras, a native of Cos, about 340 B.C. Aristotle, youremember, made no essential distinction between arteries andveins, both of which he held to contain blood: Praxagorasrecognized that the pulsation was only in the arteries, andmaintained that only the veins contained blood, and the arteriesair. As a rule the arteries are empty after death, and Praxagorasbelieved that they were filled with an aeriform fluid, a sort ofpneuma, which was responsible for their pulsation. The wordarteria, which had already been applied to the trachea, as anair-containing tube, was then attached to the arteries; onaccount of the rough and uneven character of its walls thetrachea was then called the arteria tracheia, or the rough

air-tube.[31a] We call it simply the trachea, but in French theword trachee-artere is still used.

[31a] Galen: De usu partium, VII, Chaps. 8-9.

Praxagoras was one of the first to make an exhaustive study ofthe pulse, and he must have been a man of considerable clinicalacumen,as well as boldness, to recommend in obstruction of thebowels the opening of the abdomen, removal of the obstructedportion and uniting the ends of the intestine by sutures.

After the death of Alexander, Egypt fell into the hands of hisfamous general, Ptolemy, under whose care the city became one ofthe most important on the Mediterranean. He founded andmaintained a museum, an establishment that corresponded very muchto a modern university, for the study of literature, science andthe arts. Under his successors, particularly the third Ptolemy,the museum developed, more especially the library, whichcontained more than half a million volumes. The teachers weredrawn from all centres, and the names of the great Alexandriansare among the most famous in the history of human knowledge,including such men as Archimedes, Euclid, Strabo and Ptolemy.

In mechanics and physics, astronomy, mathematics and optics, thework of the Alexandrians constitutes the basis of a large part ofour modern knowledge. The school-boy of today--or at any rate ofmy day--studies the identical problems that were set by Euclid300 B.C., and the student of physics still turns to Archimedesand Heron, and the astronomer to Eratosthenes and Hipparchus. Tothose of you who wish to get a brief review of the state ofscience in the Alexandrian School I would recommend the chapterin Vol. I of Dannemann's history.[31]

[31] Friedrich Dannemann: Grundriss einer Geschichte derNaturwissenschaften, Vol. I, 3d ed., Leipzig, 1908.

Of special interest to us in Alexandria is the growth of thefirst great medical school of antiquity. Could we have visitedthe famous museum about 300 B.C., we should have found a medicalschool in full operation, with extensive laboratories, librariesand clinics. Here for the first time the study of the structureof the human body reached its full development, till then barredeverywhere by religious prejudice; but full permission was givenby the Ptolemies to perform human dissection and, if we maycredit some authors, even vivisection. The original writings ofthe chief men of this school have not been preserved, but thereis a possibility that any day a papyrus maybe found which willsupplement the scrappy and imperfect knowledge afforded us byPliny, Celsus and Galen. The two most distinguished names areHerophilus--who, Pliny says, has the honor of being the firstphysician "who searched into the causes of disease"-- andErasistratus.

Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him,was a pupil of Praxagoras, and his name is still in everyday useby medical students, attached to the torcular Herophili. Anatomy

practically dates from these Alexandrines, who described thevalves of the heart,the duodenum, and many of the important partsof the brain; they recognized the true significance of the nerves(which before their day had been confounded with the tendons),distinguished between motor and sensory nerves, and regarded thebrain as the seat of the perceptive faculties and voluntaryaction. Herophilus counted the pulse, using the water-clock forthe purpose, and made many subtle analyses of its rate andrhythm; and, influenced by the musical theories of the period, hebuilt up a rhythmical pulse lore which continued in medicineuntil recent times. He was a skilful practitioner and to him isascribed the statement that drugs are the hands of the gods.There is a very modern flavor to his oft-quoted expression thatthe best physician was the man who was able to distinguishbetween the possible and the impossible.

Erasistratus elaborated the view of the pneuma, one form of whichhe believed came from the inspired air, and passed to the leftside of the heart and to the arteries of the body. It was thecause of the heart-beat and the source of the innate heat of thebody, and it maintained the processes of digestion and nutrition.This was the vital spirit; the animal spirit was elaborated inthe brain, chiefly in the ventricles, and sent by the nerves toall parts of the body, endowing the individual with life andperception and motion. In this way a great division was madebetween the two functions of the body, and two sets of organs:in the vascular system, the heart and arteries and abdominalorgans, life was controlled by the vital spirits; on the otherhand, in the nervous system were elaborated the animal spirits,controlling motion, sensation and the various special senses.These views on the vital and animal spirits held unquestionedsway until well into the eighteenth century, and we still, in ameasure, express the views of the great Alexandrian when we speakof "high" or "low" spirits.

GALEN

PERGAMON has become little more than a name associated in ourmemory with the fulminations of St. John against the sevenchurches of Asia; and on hearing the chapter read, we wonderedwhat was "Satan's seat" and who were the "Nicolaitanes" whosedoctrine he so hated. Renewed interest has been aroused in thestory of its growth and of its intellectual rivalry withAlexandria since the wonderful discoveries by Germanarchaeologists which have enabled us actually to see this greatIonian capital, and even the "seat of Satan." The illustrationhere shown is of the famous city, in which you can see theTemple of Athena Polis on the rock, and the amphitheatre.It sinterest for us is connected with the greatest name, afterHippocrates, in Greek medicine, that of Galen, born at PergamonA. D. 130, in whom was united as never before-- and indeed onemay say, never since--the treble combination of observer,experimenter and philosopher. His father, Nikon, a prosperousarchitect, was urged in a dream to devote his son to theprofession of medicine, upon which study the lad entered in hisseventeenth year under Satyrus. In his writings, Galen gives many

details of his life, mentioning the names of his teachers, andmany incidents in his Wanderjahre, during which he studied at thebest medical schools, including Alexandria. Returning to hisnative city he was put in charge of the gladiators, whose woundshe said he treated with wine. In the year 162, he paid his firstvisit to Rome, the scene of his greatest labors. Here he gavepublic lectures on anatomy, and became "the fashion." He mentionsmany of his successes; one of them is the well-worn story toldalso of Erasistratus and Stratonice, but Galen's story is worthtelling, and it is figured as a miniature in the manuscripts ofhis works. Called to see a lady he found her suffering fromgeneral malaise without any fever or increased action of thepulse. He saw at once that her trouble was mental and, like awise physician, engaged her in general conversation. Quitepossibly he knew her story, for the name of a certain actor,Pylades, was mentioned, and he noticed that her pulse at onceincreased in rapidity and became irregular. On the next day hearranged that the name of another actor, Morphus, should bementioned, and on the third day the experiment was repeated butwithout effect. Then on the fourth evening it was againmentioned that Pylades was dancing, and the pulse quickened andbecame irregular, so he concluded that she was in love withPylades. He tells how he was first called to treat the EmperorMarcus Aurelius, who had a stomach-ache after eating too muchcheese. He treated the case so successfully that the Emperorremarked, "I have but one physician, and he is a gentleman." Heseems to have had good fees, as he received 400 aurei (about2000) for a fortnight's attendance upon the wife of Boethus.

He left Rome for a time in 168 A. D. and returned to Pergamon,but was recalled to Rome by the Emperor, whom he accompanied onan expedition to Germany. There are records in his writings ofmany journeys, and busy with his practice in dissections andexperiments he passed a long and energetic life, dying, accordingto most authorities, in the year 200 A.D.

A sketch of the state of medicine in Rome is given by Celsus inthe first of his eight books, and he mentions the names of manyof the leading practitioners, particularly Asclepiades, theBithynian, a man of great ability, and a follower of theAlexandrians, who regarded all disease as due to a disturbedmovement of the atoms. Diet, exercise, massage and bathing werehis great remedies, and his motto--tuto, cito et jucunde--hasbeen the emulation of all physicians. How important a role heand his successors played until the time of Galen may be gatheredfrom the learned lectures of Sir Clifford Allbutt[32] on "GreekMedicine in Rome" and from Meyer-Steineg's "Theodorus Priscianusund die romische Medizin."[33] From certain lay writers we learnthat it was the custom for popular physicians to be followed ontheir rounds by crowds of students. Martial's epigram (V, ix) isoften referred to:

Languebam: sed tu comitatus protinus ad me Venisti centum, Symmache, discipulis.Centum me tegigere manus Aquilone gelatae Non habui febrem, Symmache, nunc habeo.

[32] Allbutt: British Medical Journal, London, 1909, ii, 1449;1515; 1598.

[33] Fischer, Jena, 1909.

And in the "Apollonius of Tyana" by Philostratus, when Apolloniuswishes to prove an alibi, he calls to witness the physicians ofhis sick friend, Seleucus and Straloctes, who were accompanied bytheir clinical class to the number of about thirty students.[34]But for a first-hand sketch of the condition of the profession wemust go to Pliny, whose account in the twenty-ninth book of the"Natural History" is one of the most interesting and amusingchapters in that delightful work. He quotes Cato's tirade againstGreek physicians,--corrupters of the race, whom he would havebanished from the city,--then he sketches the career of some ofthe more famous of the physicians under the Empire, some of whommust have had incomes never approached at any other period in thehistory of medicine. The chapter gives a good picture of thestage on which Galen (practically a contemporary of Pliny) was toplay so important a role. Pliny seems himself to have been ratherdisgusted with the devious paths of the doctors of his day, andthere is no one who has touched with stronger language upon theweak points of the art of physic. In one place he says that italone has this peculiar art and privilege, "That whosoeverprofesseth himself a physician, is straightwaies beleeved, saywhat he will: and yet to speake a truth, there are no liesdearer sold or more daungerous than those which proceed out of aPhysician's mouth. Howbeit, we never once regard or look to that,so blind we are in our deepe persuasion of them, and feed ourselves each one in a sweet hope and plausible conceit of ourhealth by them. Moreover, this mischief there is besides, Thatthere is no law or statute to punish the ignorance of blindPhysicians, though a man lost his life by them: neither wasthere ever any man knowne, who had revenge of recompence for theevill intreating or misusage under their hands. They learnetheir skill by endaungering our lives: and to make proofe andexperiments of their medicines, they care not to kill us."[35] Hesays it is hard that, while the judges are carefully chosen andselected, physicians are practically their own judges, and thatof the men who may give us a quick despatch and send us to Heavenor Hell, no enquiry or examination is made of their quality andworthiness. It is interesting to read so early a bitter criticismof the famous "Theriaca," a great compound medicine invented byAntiochus III, which had a vogue for fifteen hundred years.

[34] Bk. VIII, Chap. VII.

[35] Pliny: Natural History (XXIX, 1), Philemon Holland'sversion, London, 1601, II, 347.

But we must return to Galen and his works, which comprise themost voluminous body of writings left by any of the ancients. Thegreat edition is that in twenty-two volumes by Kuhn (1821-1833).The most useful editions are the "Juntines" of Venice, which wereissued in thirteen editions. In the fourth and subsequent

editions a very useful index by Brassavola is included. Acritical study of the writings is at present being made by Germanscholars for the Prussian Academy, which will issue a definitiveedition of his works.

Galen had an eclectic mind and could not identify himself withany of the prevailing schools, but regarded himself as a discipleof Hippocrates. For our purpose, both his philosophy and hispractice are of minor interest in comparison with his greatlabors in anatomy and physiology.

In anatomy, he was a pupil of the Alexandrians to whom heconstantly refers. Times must have changed since the days ofHerophilus, as Galen does not seem ever to have had anopportunity of dissecting the human body, and he laments theprejudice which prevents it. In the study of osteology, he urgesthe student to be on the lookout for an occasional human boneexposed in a graveyard, and on one occasion he tells of findingthe carcass of a robber with the bones picked bare by birds andbeasts. Failing this source, he advises the student to go toAlexandria, where there were still two skeletons. He himselfdissected chiefly apes and pigs. His osteology was admirable, andhis little tractate "De Ossibus" could, with very few changes, beused today by a hygiene class as a manual. His description of themuscles and of the organs is very full, covering, of course, manysins of omission and of commission, but it was the culmination ofthe study of the subject by Greek physicians.

His work as a physiologist was even more important, for, so faras we know, he was the first to carry out experiments on a largescale. In the first place, he was within an ace of discoveringthe circulation of the blood. You may remember that through theerrors of Praxagoras and Erasistratus, the arteries were believedto contain air and got their name on that account: Galen showedby experiment that the arteries contain blood and not air. Hestudied particularly the movements of the heart, the action ofthe valves, and the pulsatile forces in the arteries. Of the twokinds of blood, the one, contained in the venous system, was darkand thick and rich in grosser elements, and served for thegeneral nutrition of the body. This system took its origin, as isclearly shown in the figure, in the liver, the central organ ofnutrition and of sanguification. From the portal system wereabsorbed, through the stomach and intestines, the products ofdigestion. From the liver extend the venae cavae, one to supplythe head and arms, the other the lower extremities: extendingfrom the right heart was a branch, corresponding to the pulmonaryartery, the arterial vein which distributed blood to the lungs.This was the closed venous system. The arterial system, shown,as you see, quite separate in Figure 31, was full of a thinner,brighter, warmer blood, characterized by the presence of anabundance of the vital spirits. Warmed in the ventricle, itdistributed vital heat to all parts of the body. The two systemswere closed and communicated with each other only through certainpores or perforations in the septum separating the ventricles. Atthe periphery, however, Galen recognized (as had been donealready by the Alexandrians) that the arteries anastomose withthe veins, ". . . and they mutually receive from each other blood

and spirits through certain invisible and extremely smallvessels."

It is difficult to understand how Galen missed the circulation ofthe blood. He knew that the valves of the heart determined thedirection of the blood that entered and left the organ, but hedid not appreciate that it was a pump for distributing the blood,regarding it rather as a fireplace from which the innate heat ofthe body was derived. He knew that the pulsatile force wasresident in the walls of the heart and in the arteries, and heknew that the expansion, or diastole, drew blood into itscavities, and that the systole forced blood out. Apparently hisview was that there was a sort of ebb and flow in bothsystems--and yet, he uses language just such as we would,speaking of the venous system as ". . . a conduit full of bloodwith a multitude of canals large and small running out from itand distributing blood to all parts of the body." He comparesthe mode of nutrition to irrigating canals and gardens, with awonderful dispensation by nature that they should "neither lack asufficient quantity of blood for absorption nor be overloaded atany time with excessive supply." The function of respiration wasthe introduction of the pneuma, the spirits which passed from thelungs to the heart through the pulmonary vessels. Galen went agood deal beyond the idea of Aristotle, reaching our modernconception that the function is to maintain the animal heat, andthat the smoky matters derived from combustion of the blood aredischarged by expiration.

I have dwelt on these points in Galen's physiology, as they arefundamental in the history of the circulation; and they aresufficient to illustrate his position. Among his other brilliantexperiments were the demonstration of the function of thelaryngeal nerves, of the motor and sensory functions of thespinal nerve roots, of the effect of transverse incision of thespinal cord, and of the effect of hemisection. Altogether thereis no ancient physician in whose writings are contained so manyindications of modern methods of research.

Galen's views of disease in general are those of Hippocrates, buthe introduces many refinements and subdivisions according to thepredominance of the four humors, the harmonious combination ofwhich means health, or eucrasia, while their perversion orimproper combination leads to dyscrasia, or ill health. Intreatment he had not the simplicity of Hippocrates: he had greatfaith in drugs and collected plants from all parts of the knownworld, for the sale of which he is said to have had a shop in theneighborhood of the Forum. As I mentioned, he was an eclectic,held himself aloof from the various schools of the day, callingno man master save Hippocrates. He might be called a rationalempiricist. He made war on the theoretical practitioners of theday, particularly the Methodists, who, like some of their modernfollowers, held that their business was with the disease and notwith the conditions out of which it arose.

No other physician has ever occupied the commanding position of"Clarissimus" Galenus. For fifteen centuries he dominatedmedical thought as powerfully as did Aristotle in the schools.

Not until the Renaissance did daring spirits begin to questionthe infallibility of this medical pope. But here we must partwith the last and, in many ways, the greatest of the Greeks-- aman very much of our own type, who, could he visit this countrytoday, might teach us many lessons. He would smile in scorn atthe water supply of many of our cities, thinking of themagnificent aqueducts of Rome and of many of the colonialtowns--some still in use-- which in lightness of structure and indurability testify to the astonishing skill of their engineers.There are country districts in which he would find imperfectdrainage and could tell of the wonderful system by which Rome waskept sweet and clean. Nothing would delight him more than a visitto Panama to see what the organization of knowledge has been ableto accomplish. Everywhere he could tour the country as a sanitaryexpert, preaching the gospel of good water supply and gooddrainage, two of the great elements in civilization, in which inmany places we have not yet reached the Roman standard.

CHAPTER III

MEDIAEVAL MEDICINE

THERE are waste places of the earth which fill one with terror--not simply because they are waste; one has not such feelings inthe desert nor in the vast solitude of the ocean. Very differentis it where the desolation has overtaken a brilliant andflourishing product of man's head and hand. To know that

. . . the Lion and the Lizard keep The Courts where Jamshyd gloried and drank deep

sends a chill to the heart, and one trembles with a sense ofhuman instability. With this feeling we enter the Middle Ages.Following the glory that was Greece and the grandeur that wasRome, a desolation came upon the civilized world, in which thelight of learning burned low, flickering almost to extinction.How came it possible that the gifts of Athens and of Alexandriawere deliberately thrown away? For three causes. The barbariansshattered the Roman Empire to its foundations. When Alaricentered Rome in 410 A. D., ghastly was the impression made on thecontemporaries; the Roman world shuddered in a titanic spasm(Lindner). The land was a garden of Eden before them, behind ahowling wilderness, as is so graphically told in Gibbon's greathistory. Many of the most important centres of learning weredestroyed, and for centuries Minerva and Apollo forsook thehaunts of men. The other equally important cause was the changewrought by Christianity. The brotherhood of man, the care of thebody, the gospel of practical virtues formed the essence of theteaching of the Founder--in these the Kingdom of Heaven was to besought; in these lay salvation. But the world was very evil, allthought that the times were waxing late, and into men's mindsentered as never before a conviction of the importance of thefour last things--death, judgment, heaven and hell. One obstaclealone stood between man and his redemption, the vile body, "thismuddy vesture of decay," that so grossly wrapped his soul. To

find methods of bringing it into subjection was the task of theChristian Church for centuries. In the Vatican Gallery ofInscriptions is a stone slab with the single word "Stercoriae,"and below, the Christian symbol. It might serve as a motto forthe Middle Ages, during which, to quote St. Paul, all things were"counted dung but to win Christ." In this attitude of mind thewisdom of the Greeks was not simply foolishness, but astumbling-block in the path. Knowledge other than that which madea man "wise unto salvation" was useless. All that was necessarywas contained in the Bible or taught by the Church. This simplecreed brought consolation to thousands and illumined the lives ofsome of the noblest of men. But, "in seeking a heavenly home manlost his bearings upon earth." Let me commend for your readingTaylor's "Mediaeval Mind."[1] I cannot judge of its scholarship,which I am told by scholars is ripe and good, but I can judge ofits usefulness for anyone who wishes to know the story of themind of man in Europe at this period. Into the content ofmediaeval thought only a mystic can enter with full sympathy. Itwas a needful change in the evolution of the race. Christianitybrought new ideals and new motives into the lives of men. Theworld's desire was changed, a desire for the Kingdom of Heaven,in the search for which the lust of the flesh, the lust of theeye and the pride of life were as dross. A master-motive swayedthe minds of sinful men and a zeal to save other souls occupiedthe moments not devoted to the perfection of their own. The newdispensation made any other superfluous. As Tertullian said:Investigation since the Gospel is no longer necessary.(Dannemann, Die Naturw., I, p. 214.) The attitude of the earlyFathers toward the body is well expressed by Jerome. "Does yourskin roughen without baths? Who is once washed in the blood ofChrist needs not wash again." In this unfavorable medium for itsgrowth, science was simply disregarded, not in any hostilespirit, but as unnecessary.[2] And a third contributing factorwas the plague of the sixth century, which desolated the wholeRoman world. On the top of the grand mausoleum of Hadrian,visitors at Rome see the figure of a gilded angel with a drawnsword, from which the present name of the Castle of St. Angelotakes its origin. On the twenty-fifth of April, 590, there setout from the Church of SS. Cosmas and Damian, already the Romanpatron saints of medicine, a vast procession, led by St. Gregorythe Great, chanting a seven-fold litany of intercession againstthe plague. The legend relates that Gregory saw on the top ofHadrian's tomb an angel with a drawn sword, which he sheathed asthe plague abated.

[1] H. O. Taylor: The Mediaeval Mind, 2 vols., Macmillan Co.,New York, 1911. [New edition, 1920.]

[2] Ibid., Vol. 1, p. 13: "Under their action [the ChristianFathers] the peoples of Western Europe, from the eighth to thethirteenth century, passed through a homogeneous growth, andevolved a spirit different from that of any other period ofhistory--a spirit which stood in awe before its monitors divineand human, and deemed that knowledge was to be drawn from thestorehouse of the past; which seemed to rely on everything exceptits sin-crushed self, and trusted everything except its senses;which in the actual looked for the ideal, in the concrete saw the

symbol, in the earthly Church beheld the heavenly, and in fleshlyjoys discerned the devil's lures; which lived in the unreconciledopposition between the lust and vain-glory of earth and theattainment of salvation; which felt life's terror and itspitifulness, and its eternal hope; around which waved concreteinfinitudes, and over which flamed the terror of darkness and theJudgment Day."

Galen died about 200 A.D.; the high-water mark of theRenaissance, so far as medicine is concerned, was reached in theyear 1542. In order to traverse this long interval intelligently,I will sketch certain great movements, tracing the currents ofGreek thought, setting forth in their works the lives of certaingreat leaders, until we greet the dawn of our own day.

After flowing for more than a thousand years through the broadplain of Greek civilization, the stream of scientific medicinewhich we have been following is apparently lost in the morass ofthe Middle Ages; but, checked and blocked like the White Nile inthe Soudan, three channels may be followed through the weeds oftheological and philosophical speculation.

SOUTH ITALIAN SCHOOL

A WIDE stream is in Italy, where the "antique education neverstopped, antique reminiscence and tradition never passed away,and the literary matter of the pagan past never faded from theconsciousness of the more educated among the laity andclergy."[3] Greek was the language of South Italy and was spokenin some of its eastern towns until the thirteenth century. Thecathedral and monastic schools served to keep alive the ancientlearning. Monte Casino stands pre-eminent as a great hive ofstudents, and to the famous Regula of St. Benedict[4] we areindebted for the preservation of many precious manuscripts.

[3] H. O. Taylor: The Mediaeval Mind, Vol. I, p. 251.

[4] De Renzi: Storia Documentata della Scuola Medica di Salerno,2d ed., Napoli, 1867, Chap. V.

The Norman Kingdom of South Italy and Sicily was a meeting groundof Saracens, Greeks and Lombards. Greek, Arabic and Latin werein constant use among the people of the capital, and Sicilianscholars of the twelfth century translated directly from theGreek.

The famous "Almagest" of Ptolemy, the most important work ofancient astronomy, was translated from a Greek manuscript, asearly as 1160, by a medical student of Salerno.[5]

[5] Haskins and Lockwood: Harvard Studies in ClassicalPhilology, 1910, XXI, pp. 75-102.

About thirty miles southeast of Naples lay Salernum, which forcenturies kept alight the lamp of the old learning, and becamethe centre of medical studies in the Middle Ages; well deservingits name of "Civitas Hippocratica." The date of foundation isuncertain, but Salernitan physicians are mentioned as early asthe middle of the ninth century, and from this date until therise of the universities it was not only a great medical school,but a popular resort for the sick and wounded. As the scholarsays in Longfellow's "Golden Legend":

Then at every season of the year There are crowds of guests and travellers here; Pilgrims and mendicant friars and traders From the Levant, with figs and wine, And bands of wounded and sick Crusaders, Coming back from Palestine.

There were medical and surgical clinics, foundling hospitals,Sisters of Charity, men and women professors--among the latterthe famous Trotula--and apothecaries. Dissections were carriedout, chiefly upon animals, and human subjects were occasionallyused. In the eleventh and twelfth centuries, the school reachedits height, and that remarkable genius, Frederick II, laid downregulations for a preliminary study extending over three years,and a course in medicine for five years, including surgery. Feetables and strict regulations as to practice were made; and it isspecifically stated that the masters were to teach in theschools, theoretically and practically, under the authority ofHippocrates and Galen. The literature from the school had afar-reaching influence. One book on the anatomy of the pigillustrates the popular subject for dissection at that time.[6]The writings, which are numerous, have been collected by DeRenzi.[7]

[6] "And dissections of the bodies of swine As likest the human form divine."--Golden Legend.

[7] S. de Renzi: Collectio Salernitana, 5 vols., Naples,1852-1859; P. Giacosa: Magistri Salernitani, Turin, 1901.

The "Antidotarium" of Nicolaus Salernitanus, about 1100, becamethe popular pharmacopoeia of the Middle Ages, and many modernpreparations may be traced to it.

The most prominent man of the school is Constantinus Africanus, anative of Carthage, who, after numerous journeys, reachedSalernum about the middle of the eleventh century. He wasfamiliar with the works both of the Greeks and of the Arabs, andit was largely through his translations that the works of Rhazesand Avicenna became known in the West.

One work above all others spread the fame of the school--theRegimen Sanitatis, or Flos Medicinae as it is sometimes called, apoem on popular medicine. It is dedicated to Robert of Normandy,who had been treated at Salernum, and the lines begin: "Anglorum

regi scripsit schola tota Salerni . . . " It is a hand-book ofdiet and household medicine, with many shrewd and taking sayingswhich have passed into popular use, such as "Joy, temperance andrepose Slam the door on the doctor's nose." A full account of thework and the various editions of it is given by Sir AlexanderCroke,[8] and the Finlayson lecture (Glasgow Medical Journal,1908) by Dr. Norman Moore gives an account of its introductioninto the British Isles.

[8] Regimen Sanitutis Salernitanum; a Poem on the Preservation ofHealth in Rhyming Latin Verse, Oxford, D.A. Talboys, 1830.

BYZANTINE MEDICINE

THE second great stream which carried Greek medicine to moderndays runs through the Eastern Empire. Between the third centuryand the fall of Constantinople there was a continuous series ofByzantine physicians whose inspiration was largely derived fromthe old Greek sources. The most distinguished of these wasOribasius, a voluminous compiler, a native of Pergamon and soclose a follower of his great townsman that he has been called"Galen's ape." He left many works, an edition of which wasedited by Bussemaker and Daremberg. Many facts relating to theolder writers are recorded in his writings. He was acontemporary, friend as well as the physician, of the EmperorJulian, for whom he prepared an encyclopaedia of the medicalsciences.

Other important Byzantine writers were Aetius and Alexander ofTralles, both of whom were strongly under the influence of Galenand Hippocrates. Their materia medica was based largely uponDioscorides.

From Byzantium we have the earliest known complete medicalmanuscript, dating from the fifth century--a work ofDioscorides--one of the most beautiful in existence. It wasprepared for Anicia Juliana, daughter of the Emperor of the East,and is now one of the great treasures of the Imperial Library atVienna.[9] From those early centuries till the fall ofConstantinople there is very little of interest medically. A fewnames stand out prominently, but it is mainly a blank period inour records. Perhaps one man may be mentioned, as he had a greatinfluence on later ages--Actuarius, who lived about 1300, andwhose book on the urine laid the foundation of much of thepopular uroscopy and water-casting that had such a vogue in thesixteenth and seventeenth centuries. His work on the subjectpassed through a dozen Latin editions, but is best studied inIdeler's "Physici et medici Graeci minores" (Berlin, 1841).

[9] It has been reproduced by Seatone de Vries, Leyden, 1905,Codices graeci et latini photographice depicti, Vol. X.

The Byzantine stream of Greek medicine had dwindled to a verytiny rill when the fall of Constantinople (1453) dispersed to theWest many Greek scholars and many precious manuscripts.

ARABIAN MEDICINE

THE third and by far the strongest branch of the Greek riverreached the West after a remarkable and meandering course. Themap before you shows the distribution of the Graeco-RomanChristian world at the beginning of the seventh century. You willnotice that Christianity had extended far eastwards, almost toChina. Most of those eastern Christians were Nestorians and oneof their important centres was Edessa, whose school of learningbecame so celebrated. Here in the fifth century was built one ofthe most celebrated hospitals of antiquity.

Now look at another map showing the same countries about acentury later. No such phenomenal change ever was made within soshort space of time as that which thus altered the map of Asiaand Europe at this period. Within a century, the Crescent hadswept from Arabia through the Eastern Empire, over Egypt, NorthAfrica and over Spain in the West, and the fate of Western Europehung in the balance before the gates of Tours in 732. This timethe barbaric horde that laid waste a large part of Christendomwere a people that became deeply appreciative of all that wasbest in Graeco-Roman civilization and of nothing more than of itssciences. The cultivation of medicine was encouraged by the Arabsin a very special way. Anyone wishing to follow the history ofthe medical profession among this remarkable people will find itadmirably presented in Lucien Leclerc's "Histoire de la medecinearabe" (Paris, 1876). An excellent account is also given inFreind's well-known "History of Medicine" (London, 1725-1726).Here I can only indicate very briefly the course of the streamand its freightage.

With the rise of Christianity, Alexandria became a centre ofbitter theological and political factions, the story of whichhaunts the memory of anyone who was so fortunate as to read inhis youth Kingsley's "Hypatia." These centuries, with theirpotent influence of neoplatonism on Christianity, appear to havebeen sterile enough in medicine. I have already referred to thelate Greeks, Aetius and Alexander of Tralles. The last of theAlexandrians was a remarkable man, Paul of AEgina, a great namein medicine and in surgery, who lived in the early part of theseventh century. He also, like Oribasius, was a great compiler.In the year 640, the Arabs took Alexandria, and for the thirdtime a great library was destroyed in the "first city of theWest." Shortly after the conquest of Egypt, Greek works weretranslated into Arabic, often through the medium of Syriac,particularly certain of Galen's books on medicine, and chemicalwritings, which appear to have laid the foundation of Arabianknowledge on this subject.

Through Alexandria then was one source: but the specialdevelopment of the Greek science and of medicine took place inthe ninth century under the Eastern Caliphates. Let me quotehere a couple of sentences from Leclerc (Tome I, pp. 91-92):

"The world has but once witnessed so marvellous a spectacle as

that presented by the Arabs in the ninth century. This pastoralpeople, whose fanaticism had suddenly made them masters of halfof the world, having once founded their empire, immediately setthemselves to acquire that knowledge of the sciences which alonewas lacking to their greatness. Of all the invaders who competedfor the last remains of the Roman Empire they alone pursued suchstudies; while the Germanic hordes, glorying in their brutalityand ignorance, took a thousand years to re-unite the broken chainof tradition, the Arabs accomplished this in less than a century.They provoked the competition of the conquered Christians-- ahealthy competition which secured the harmony of the races.

"At the end of the eighth century, their whole scientificpossessions consisted of a translation of one medical treatiseand some books on alchemy. Before the ninth century had run toits close, the Arabs were in possession of all the science of theGreeks; they had produced from their own ranks students of thefirst order, and had raised among their initiators men who,without them, would have been groping in the dark; and theyshowed from this time an aptitude for the exact sciences, whichwas lacking in their instructors, whom they henceforwardsurpassed."

It was chiefly through the Nestorians that the Arabs becameacquainted with Greek medicine, and there were two famousfamilies of translators, the Bakhtishuas and the Mesues, bothSyrians, and probably not very thoroughly versed in either Greekor Arabic. But the prince of translators, one of the finestfigures of the century, was Honein, a Christian Arab, born in809, whose name was Latinized as Joannitius. "The marvellousextent of his works, their excellence, their importance, thetrials he bore nobly at the beginning of his career, everythingabout him arouses our interest and sympathy. If he did notactually create the Oriental renaissance movement, certainly noone played in it a more active, decided and fruitful part."[10]His industry was colossal. He translated most of the works ofHippocrates and Galen, Aristotle and many others. His famous"Introduction" or "Isagoge," a very popular book in the MiddleAges, is a translation of the "Microtegni" of Galen, a smallhand-book, of which a translation is appended to Cholmeley's"John of Gaddesden."[11] The first printed edition of it appearedin 1475 [see Chapter IV] at Padua.

[10] Leclerc: Histoire de la medecine arabe, Tome I, p. 139.

[11] Oxford, Clarendon Press, 1912, pp. 136-166. The Mesues alsodid great work, and translations of their compilations,particularly those of the younger Mesue, were widely distributedin manuscript and were early printed (Venice, 1471) andfrequently reprinted, even as late as the seventeenth century.

Leclerc gives the names of more than one hundred knowntranslators who not only dealt with the physicians but with theGreek philosophers, mathematicians and astronomers. The writingsof the physicians of India and of Persia were also translatedinto Arabic.

But close upon the crowd of translators who introduced thelearning of Greece to the Arabians came original observers of thefirst rank, to a few only of whom time will allow me to refer.Rhazes, so called from the name of the town (Rai) in which he wasborn, was educated at the great hospital at Bagdad in the secondhalf of the ninth century. With a true Hippocratic spirit he mademany careful observations on disease, and to him we owe the firstaccurate account of smallpox, which he differentiated frommeasles. This work was translated for the old Sydenham Societyby W.A. Greenhill (1848), and the description given of thedisease is well worth reading. He was a man of strong powers ofobservation, good sense and excellent judgment. His works werevery popular, particularly the gigantic "Continens," one of thebulkiest of incunabula. The Brescia edition, 1486, a magnificentvolume, extends over 588 pages and it must weigh more thanseventeen pounds. It is an encyclopaedia filled with extractsfrom the Greek and other writers, interspersed with memoranda ofhis own experiences. His "Almansor" was a very populartext-book, and one of the first to be printed. Book IX of"Almansor" (the name of the prince to whom it was addressed) withthe title "De aegritudinibus a capite usque ad pedes," was a veryfavorite mediaeval text-book. On account of his zeal for studyRhazes was known as the "Experimentator."

The first of the Arabians, known throughout the Middle Ages asthe Prince, the rival, indeed, of Galen, was the Persian IbnSina, better known as Avicenna, one of the greatest names in thehistory of medicine. Born about 980 A. D. in the province ofKhorasan, near Bokhara, he has left a brief autobiography fromwhich we learn something of his early years. He could repeat theKoran by heart when ten years old, and at twelve he had disputedin law and in logic. So that he found medicine was an easysubject, not hard and thorny like mathematics and metaphysics! Heworked night and day, and could solve problems in his dreams."When I found a difficulty," he says, "I referred to my notes andprayed to the Creator. At night, when weak or sleepy, Istrengthened myself with a glass of wine."[12] He was avoluminous writer to whom scores of books are attributed, and heis the author of the most famous medical text-book ever written.It is safe to say that the "Canon" was a medical bible for alonger period than any other work. It "stands for the epitome ofall precedent development, the final codification of allGraeco-Arabic medicine. It is a hierarchy of laws liberallyillustrated by facts which so ingeniously rule and are subject toone another, stay and uphold one another, that admiration iscompelled for the sagacity of the great organiser who, withunparalleled power of systematisation, collecting his materialfrom all sources, constructed so imposing an edifice of fallacy.Avicenna, according to his lights, imparted to contemporarymedical science the appearance of almost mathematical accuracy,whilst the art of therapeutics, although empiricism did notwholly lack recognition, was deduced as a logical sequence fromtheoretical (Galenic and Aristotelian) premises. Is it,therefore, matter for surprise that the majority of investigatorsand practitioners should have fallen under the spell of thisconsummation of formalism and should have regarded the 'Canon' asan infallible oracle, the more so in that the logical

construction was impeccable and the premises, in the light ofcontemporary conceptions, passed for incontrovertibleaxioms?"[13]

[12] Withington: Medical History, London, 1894, pp. 151-152.

[13] Neuburger: History of Medicine, Vol. I, pp. 368-369.

Innumerable manuscripts of it exist: of one of the mostbeautiful, a Hebrew version (Bologna Library), I give anillustration. A Latin version was printed in 1472 and there aremany later editions, the last in 1663. Avicenna was not only asuccessful writer, but the prototype of the successful physicianwho was at the same time statesman, teacher, philosopher andliterary man. Rumor has it that he became dissipated, and acontemporary saying was that all his philosophy could not makehim moral, nor all his physic teach him to preserve his health.He enjoyed a great reputation as a poet. I reproduce a page of amanuscript of one of his poems, which we have in the BodleianLibrary. Prof. A.V.W. Jackson says that some of his verse ispeculiarly Khayyamesque, though he antedated Omar by a century.That "large Infidel" might well have written such a stanza as

From Earth's dark centre unto Saturn's GateI've solved all problems of this world's Estate,From every snare of Plot and Guile set free,Each bond resolved, saving alone Death's Fate.

His hymn to the Deity might have been written by Plato and rivalsthe famous one of Cleanthes.[14] A casual reader gets a veryfavorable impression of Avicenna. The story of his dominion overthe schools in the Middle Ages is one of the most striking in ourhistory. Perhaps we feel that Leclerc exaggerates when he says:"Avicenna is an intellectual phenomenon. Never perhaps has anexample been seen of so precocious, quick and wide an intellectextending and asserting itself with so strange and indefatigablean activity." The touch of the man never reached me until I readsome of his mystical and philosophical writings translated byMehren.[15] It is Plato over again. The beautiful allegory inwhich men are likened to birds snared and caged until set free bythe Angel of Death might be met with anywhere in the immortalDialogues. The tractate on Love is a commentary on theSymposium; and the essay on Destiny is Greek in spirit without atrace of Oriental fatalism, as you may judge from the concludingsentence, which I leave you as his special message: "Take heed tothe limits of your capacity and you will arrive at a knowledge ofthe truth! How true is the saying:--Work ever and to each willcome that measure of success for which Nature has designed him."Avicenna died in his fifty-eighth year. When he saw that physicwas of no avail, resigning himself to the inevitable, he sold hisgoods, distributed the money to the poor, read the Koran throughonce every three days, and died in the holy month of Ramadan.His tomb at Hamadan, the ancient Ecbatana, still exists, a simplebrickwork building, rectangular in shape, and surrounded by anunpretentious court. It was restored in 1877, but is again inneed of repair. The illustration here shown is from a photograph

sent by Dr. Neligan of Teheran. Though dead, the great Persianhas still a large practice, as his tomb is much visited bypilgrims, among whom cures are said to be not uncommon.

[14] "L'hymne d'Avicenne" in: L'Elegie du Tograi, etc., par P.Vattier, Paris, 1660.

[15] Traites mystiques d'Abou Ali al-Hosain b. Abdallah b. Sinaou d'Avicenne par M. A. F. Mehren, Leyden, E. J. Brill, Fasc.I-IV, 1889-1899.

The Western Caliphate produced physicians and philosophers almostas brilliant as those of the East. Remarkable schools ofmedicine were founded at Seville, Toledo and Cordova. The mostfamous of the professors were Averroes, Albucasis and Avenzoar.Albucasis was "the Arabian restorer of surgery." Averroes,called in the Middle Ages "the Soul of Aristotle" or "theCommentator," is better known today among philosophers thanphysicians. On the revival of Moslem orthodoxy he fell upon evildays, was persecuted as a free-thinker, and the saying isattributed to him--"Sit anima mea cum philosophic."

Arabian medicine had certain very definite characteristics: thebasis was Greek, derived from translations of the works ofHippocrates and Galen. No contributions were made to anatomy, asdissections were prohibited, nor to physiology, and the pathologywas practically that of Galen. Certain new and importantdiseases were described; a number of new and active remedies wereintroduced, chiefly from the vegetable kingdom. The Arabianhospitals were well organized and were deservedly famous. No suchhospital exists today in Cairo as that which was built byal-Mansur Gilafun in 1283. The description of it by Makrizi,quoted by Neuburger,[16] reads like that of a twentieth centuryinstitution with hospital units.

[16] "I have founded this institution for my equals and for thosebeneath me, it is intended for rulers and subjects, for soldiersand for the emir, for great and small, freemen and slaves, menand women." "He ordered medicaments, physicians and everythingelse that could be required by anyone in any form of sickness;placed male and female attendants at the disposal of thepatients, determined their pay, provided beds for patients andsupplied them with every kind of covering that could be requiredin any complaint. Every class of patient was accorded separateaccommodation: the four halls of the hospital were set apart forthose with fever and similar complaints; one part of the buildingwas reserved for eye-patients, one for the wounded, one for thosesuffering from diarrhoea, one for women; a room for convalescentswas divided into two parts, one for men and one for women. Waterwas laid on to all these departments. One room was set apart forcooking food, preparing medicine and cooking syrups, another forthe compounding of confections, balsams, eye-salves, etc. Thehead-physician had an apartment to himself wherein he deliveredmedical lectures. The number of patients was unlimited, everysick or poor person who came found admittance, nor was theduration of his stay restricted, and even those who were sick at

home were supplied with every necessity."--Makrizi.

"In later times this hospital was much extended and improved. Thenursing was admirable and no stint was made of drugs andappliances; each patient was provided with means upon leaving sothat he should not require immediately to undertake heavy work."Neuburger: History of Medicine, Vol. 1, p. 378.

It was in the domain of chemistry that the Arabs made thegreatest advances. You may remember that, in Egypt, chemistryhad already made considerable strides, and I alluded to Prof.Elliot Smith's view that one of the great leaps in civilizationwas the discovery in the Nile Valley of the metallurgy of copper.In the brilliant period of the Ptolemies, both chemistry andpharmacology were studied, and it seems not improbable that, whenthe Arabs took Alexandria in the year 640, there were still manyworkers in these subjects.

The most famous of those early Arabic writers is the somewhatmythical Geber, who lived in the first half of the eighthcentury, and whose writings had an extraordinary influencethroughout the Middle Ages. The whole story of Geber isdiscussed by Berthelot in his "La chimie au moyen age" (Paris,1896). The transmission of Arabian science to the Occident beganwith the Crusades, though earlier a filtering of importantknowledge in mathematics and astronomy had reached Southern andMiddle Europe through Spain. Among the translators several namesstand out prominently. Gerbert, who became later Pope SylvesterII, is said to have given us our present Arabic figures. You mayread the story of his remarkable life in Taylor,[17] who says hewas "the first mind of his time, its greatest teacher, its mosteager learner, and most universal scholar." But he does not seemto have done much directly for medicine.

[17] The Mediaeval Mind, Vol. I, p. 280.

The Graeco-Arabic learning passed into Europe through twosources. As I have already mentioned, Constantinus Africanus, aNorth African Christian monk, widely travelled and learned inlanguages, came to Salernum and translated many works from Arabicinto Latin, particularly those of Hippocrates and Galen. The"Pantegni" of the latter became one of the most populartext-books of the Middle Ages. A long list of other works whichhe translated is given by Steinschneider.[17a] It is not unlikelythat Arabic medicine had already found its way to Salernum beforethe time of Constantine, but the influence of his translationsupon the later Middle Ages was very great.

[17a] Steinschneider: Virchow's Arch., Berl., 1867, xxxvii, 351.

The second was a more important source through the Latintranslators in Spain, particularly in Toledo, where, from themiddle of the twelfth till the middle of the thirteenth century,an extraordinary number of Arabic works in philosophy,

mathematics and astronomy were translated. Among the translators,Gerard of Cremona is prominent, and has been called the "Fatherof Translators." He was one of the brightest intelligences ofthe Middle Ages, and did a work of the first importance toscience, through the extraordinary variety of material he put incirculation. Translations, not only of the medical writers, butof an indiscriminate crowd of authors in philosophy and generalliterature, came from his pen. He furnished one of the firsttranslations of the famous "Almagest" of Ptolemy, which openedthe eyes of his contemporaries to the value of the Alexandrianastronomy.[18] Leclerc gives a list of seventy-one works from hishand.

[18] For an account of that remarkable work see Germantranslation by Manitius, Leipzig, 1912.

Many of the translators of the period were Jews, and many of theworks were translated from Hebrew into Latin. For years Arabichad been the learned language of the Jews, and in a large measureit was through them that the Arabic knowledge and thetranslations passed into South and Central Europe.

The Arab writer whose influence on mediaeval thought was the mostprofound was Averroes, the great commentator on Aristotle.

THE RISE OF THE UNIVERSITIES

THE most striking intellectual phenomenon of the thirteenthcentury is the rise of the universities. The story of theirfoundation is fully stated in Rashdall's great work (Universitiesof Europe in the Middle Ages, Oxford, 1895). Monastic andcollegiate schools, seats of learning like Salernum, studentguilds as at Bologna, had tried to meet the educational needs ofthe age. The word "university" literally means an association,and was not at first restricted to learned bodies. The originappears to have been in certain guilds of students formed formutual protection associated at some place specially favorablefor study--the attraction generally being a famous teacher. TheUniversity of Bologna grew up about guilds formed by students oflaw, and at Paris, early in the twelfth century, there werecommunities of teachers, chiefly in philosophy and theology. Inthis way arose two different types of mediaeval university. Theuniversities of Northern Italy were largely controlled bystudents, who were grouped in different "nations." They arrangedthe lectures and had control of the appointment of teachers. Onthe other hand, in the universities founded on the Paris modelthe masters had control of the studies, though the students, alsoin nations, managed their own affairs.

Two universities have a special interest at this period inconnection with the development of medical studies, Bologna andMontpellier. At the former the study of anatomy was revived. Inthe knowledge of the structure of the human body no advance hadbeen made for more than a thousand years--since Galen's day. In

the process of translation from Greek to Syriac, from Syriac toArabic, from Arabic to Hebrew, and from Hebrew or Arabic toLatin, both the form and thought of the old Greek writers werenot infrequently confused and often even perverted, and Galen'sanatomy had suffered severely in the transmission. Our earliestknowledge of the teaching of medicine at Bologna is connectedwith a contemporary of Dante, Taddeo Alderotti, who combinedArabian erudition with the Greek spirit. He occupied a positionof extraordinary prominence, was regarded as the first citizen ofBologna and a public benefactor exempt from the payment of taxes.That he should have acquired wealth is not surprising if hisusual fees were at the rate at which he charged Pope Honorius IV,i.e., two hundred florins a day, besides a "gratification" of sixthousand florins.

The man who most powerfully influenced the study of medicine inBologna was Mundinus, the first modern student of anatomy. Wehave seen that at the school of Salernum it was decreed that thehuman body should be dissected at least once every five years,but it was with the greatest difficulty that permission wasobtained for this purpose. It seems probable that under thestrong influence of Taddeo there was an occasional dissection atBologna, but it was not until Mundinus (professor from 1306 to1326) took the chair that the study of anatomy became popular.The bodies were usually those of condemned criminals, but in theyear 1319 there is a record of a legal procedure against fourmedical students for body-snatching--the first record, as far asI know, of this gruesome practice. In 1316, Mundinus issued hiswork on anatomy, which served as a text-book for more than twohundred years. He quotes from Galen the amusing reasons why a manshould write a book: "Firstly, to satisfy his own friends;secondly, to exercise his best mental powers; and thirdly, to besaved from the oblivion incident to old age." Scores ofmanuscripts of his work must have existed, but they are nowexcessively rare in Italy. The book was first printed at Paviain 1478, in a small folio without figures. It was very oftenreprinted in the fifteenth and sixteenth centuries. The quaintillustration shows us the mediaeval method of teaching anatomy:the lecturer sitting on a chair reading from Galen, while abarber surgeon, or an "Ostensor," opens the cavities of the body.

I have already referred to the study of medicine by women atSalernum. Their names are also early met with in the school ofBologna. Mundinus is said to have had a valuable assistant, ayoung girl, Alessandra Giliani, an enthusiastic dissector, whowas the first to practice the injection of the blood vessels withcolored liquids. She died, consumed by her labors, at the earlyage of nineteen, and her monument is still to be seen.

Bologna honored its distinguished professors with magnificenttombs, sixteen or seventeen of which, in a wonderful state ofpreservation, may still be seen in the Civic Museum. That ofMundinus also exists--a sepulchral bas-relief on the wall of theChurch of San Vitale at Bologna.[19]

[19] For these figures and for points relating to the old schoolat Bologna see F. G. Cavezza: Le Scuole dell' antico Studio

Bolognese, Milano, 1896.

The other early mediaeval university of special interest inmedicine is that of Montpellier. With it are connected threeteachers who have left great names in our story--Arnold ofVillanova, Henri de Mondeville and Guy de Chauliac. The city wasvery favorably situated not far from the Spanish border, and thereceding tide of the Arab invasion in the eighth century had lefta strong Arabic influence in that province. The date of theorigin of the university is uncertain, but there were teachers ofmedicine there in the twelfth century, though it was not until1289 that it was formally founded by a papal bull.

Arnold of Villanova was one of the most prolific writers of theMiddle Ages. He had travelled much, was deeply read in Arabicmedicine and was also a student of law and of philosophy. He wasan early editor of the Regimen Sanitatis, and a strong advocateof diet and hygiene. His views on disease were largely those ofthe Arabian physicians, and we cannot see that he himself madeany very important contribution to our knowledge; but he was aman of strong individuality and left an enduring mark onmediaeval medicine, as one may judge from the fact that among thefirst hundred medical books printed there were many associatedwith his name. He was constantly in trouble with the Church,though befriended by the Popes on account of his medicalknowledge. There is a Bull of Clement V asking the bishops tosearch for a medical book by Arnold dedicated to himself, but notmany years later his writings were condemned as heretical.

In Henri de Mondeville we have the typical mediaeval surgeon, andwe know his work now very thoroughly from the editions of his"Anatomy" and "Surgery" edited by Pagel (Berlin, 1889-1892), andthe fine French edition by Nicaise (Paris, 1893). The dominantArabic influence is seen in that he quotes so large a proportionof these authors, but he was an independent observer and apractical surgeon of the first rank. He had a sharp wit andemployed a bitter tongue against the medical abuses of his day.How the Hippocratic humors dominated practice at this time youmay see at a glance from the table prepared by Nicaise from theworks of de Mondeville. We have here the whole pathology of theperiod.

===============================================================

TABLEAU DES HUMEURSD'APRES H. DE MONDEVILLE Flegme naturel. F. aqueux.Flegme F. mucilagineux. F. vitreux. Flegme non naturel F sale. F. doux. F. pontique, 2 especes. F. acide, 2 especes. Bile naturelle.Bile B. citrine.

B. vitelline Bile non naturelle B. praline. B. aerugineuse. B. brulee, 3 especes.Sang naturel. non naturel, 5 especes.Melancolie naturelle. non naturelle, 5 especes.===============================================================

A still greater name in the history of this school is Guy deChauliac, whose works have also been edited by Nicaise (Paris,1890). His "Surgery" was one of the most important text-books ofthe late Middle Ages. There are many manuscripts of it, somefourteen editions in the fifteenth century and thirty-eight inthe sixteenth, and it continued to be reprinted far into theseventeenth century. He too was dominated by the surgery of theArabs, and on nearly every page one reads of the sages Avicenna,Albucasis or Rhazes. He lays down four conditions necessary forthe making of a surgeon--the first is that he must be learned,the second, expert, the third that he should be clever, and thefourth that he should be well disciplined.

You will find a very discerning sketch of the relation of thesetwo men to the history of surgery in the address given at the St.Louis Congress in 1904 by Sir Clifford Allbutt.[20] They werestrong men with practical minds and good hands, whose experiencetaught them wisdom. In both there was the blunt honesty that sooften characterizes a good surgeon, and I commend to modernsurgeons de Mondeville's saying: "If you have operatedconscientiously on the rich for a proper fee, and on the poor forcharity, you need not play the monk, nor make pilgrimages foryour soul."

[20] Allbutt: Historical Relations of Medicine and Surgery,London, Macmillan Co., 1905.

One other great mediaeval physician may be mentioned, Peter ofAbano (a small town near Padua, famous for its baths). He is thefirst in a long line of distinguished physicians connected withthe great school of Padua. Known as "the Conciliator," from hisattempt to reconcile the diverse views on philosophy andmedicine, he had an extraordinary reputation as a practitionerand author, the persistence of which is well illustrated by thefact that eight of the one hundred and eighty-two medical booksprinted before 1481 were from his pen. He seems to have taughtmedicine in Paris, Bologna and Padua. He was a devotedastrologer, had a reputation among the people as a magician and,like his contemporary, Arnold of Villanova, came into conflictwith the Church and appears to have been several times before theInquisition; indeed it is said that he escaped the stake only bya timely death. He was a prolific commentator on Aristotle, andhis exposition of the "problems" had a great vogue. The earlyeditions of his texts are among the most superb works everprinted. He outlived his reputation as a magician, and more thana century after his death Frederick, Duke of Urbino, caused his

effigies to be set up over the gate of the palace at Padua withthis inscription:

PETRUS APONUS PATAVINUS PHILOSOPHIAE MEDICINAEQUESCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMENADEPTUS, ASTROLOGIAE VERO ADEO PERITUS,UT IN MAGIAE SUSPICIONEM INCIDERIT,FALSOQUE DE HAERESI POSTULATUS,ABSOLUTUS FUERIT.[21]

[21] Naude: History of Magick, London, 1657, p. 182, or theoriginal: Apologie pour les grands hommes soupconnez de magic,e.g., ed. Amst., 1719, p. 275.

It is said that Abano caused to be painted the astronomicalfigures in the great hall of the palace at Padua.

One characteristic of mediaeval medicine is its union withtheology, which is not remarkable, as the learning of the timewas chiefly in the hands of the clergy. One of the most popularworks, the "Thesaurus Pauperum," was written by Petrus Hispanus,afterwards Pope John XXI. We may judge of the pontificalpractice from the page here reproduced, which probably includes,under the term "iliac passion," all varieties of appendicitis.

For our purpose two beacons illuminate the spirit of thethirteenth century in its outlook on man and nature. Better thanAbelard or St. Thomas Aquinas, and much better than anyphysicians, Albertus Magnus and Roger Bacon represent the men whowere awake to greet the rising of the sun of science. What acontrast in their lives and in their works! The great Dominican'slong life was an uninterrupted triumph of fruitfulaccomplishment--the titanic task he set himself was not onlycompleted but was appreciated to the full by his own generation--a life not only of study and teaching, but of practical piety. Ashead of the order in Germany and Bishop of Regensburg, he hadwide ecclesiastical influence; and in death he left a memoryequalled only by one or two of his century, and excelled only byhis great pupil, Thomas Aquinas. There are many Alberts inhistory-- the Good, the Just, the Faithful--but there is only onewe call "Magnus" and he richly deserved the name. What is hisrecord? Why do we hold his name in reverence today?

Albertus Magnus was an encyclopaedic student and author, who tookall knowledge for his province. His great work and his greatambition was to interpret Aristotle to his generation. Before hisday, the Stagirite was known only in part, but he put within thereach of his contemporaries the whole science of Aristotle, andimbibed no small part of his spirit. He recognized theimportance of the study of nature, even of testing it by way ofexperiment, and in the long years that had elapsed sinceTheophrastus no one else, except Dioscorides, had made sothorough a study of botany. His paraphrases of the naturalhistory books of Aristotle were immensely popular, and served asa basis for all subsequent studies. Some of his medical works hadan extraordinary vogue, particularly the "De Secretis Mulierum"

and the "De Virtutibus Herbarum," but there is some doubt as tothe authorship of the first named, although Jammy and Borgnetinclude it in the collected editions of his works. So fabulouswas his learning that he was suspected of magic and comes inNaude's list of the wise men who have unjustly been reputedmagicians. Ferguson tells[22] that "there is in actualcirculation at the present time a chapbook. . . containingcharms, receipts, sympathetical and magicalcures for man andanimals, . . . which passes under the name of Albertus." Butperhaps the greatest claim of Albertus to immortality is that hewas the teacher and inspirer of Thomas Aquinas, the man whoundertook the colossal task of fusing Aristotelian philosophywith Christian theology, and with such success that the "angelicdoctor" remains today the supreme human authority of the RomanCatholic Church.

[22] Bibliotheca Chemica, 1906, Vol. I, p. 15.

A man of much greater interest to us from the medical point ofview is Roger Bacon and for two reasons. More than any othermediaeval mind he saw the need of the study of nature by a newmethod. The man who could write such a sentence as this:"Experimental science has three great prerogatives over othersciences; it verifies conclusions by direct experiment; itdiscovers truth which they never otherwise would reach; itinvestigates the course of nature and opens to us a knowledge ofthe past and of the future," is mentally of our day andgeneration. Bacon was born out of due time, and hiscontemporaries had little sympathy with his philosophy, and stillless with his mechanical schemes and inventions. From the days ofthe Greeks, no one had had so keen an appreciation of whatexperiment meant in the development of human knowledge, and hewas obsessed with the idea, so commonplace to us, that knowledgeshould have its utility and its practical bearing. "His chiefmerit is that he was one of the first to point the way tooriginal research--as opposed to the acceptance of anauthority--though he himself still lacked the means of pursuingthis path consistently. His inability to satisfy this impulse ledto a sort of longing, which is expressed in the numerous passagesin his works where he anticipates man's greater mastery overnature."[23]

[23] Dannemann: Die Naturwissenschaften in ihrer Entwicklung undin ibrem Zusammenhange,Leipzig, 1910, Vol. I, pp. 278-279.

Bacon wrote a number of medical treatises, most of which remainin manuscript. His treatise on the "Cure of Old Age and thePreservation of Youth" was printed in English in 1683.[24] Hisauthorities were largely Arabian. One of his manuscripts is "Onthe Bad Practices of Physicians." On June 10, 1914, the eve ofhis birth, the septencentenary of Roger Bacon will be celebratedby Oxford, the university of which he is the most distinguishedornament. His unpublished MSS. in the Bodleian will be issued bythe Clarendon Press [1915-1920], and it is hoped that hisunpublished medical writings will be included.

[24] It may be interesting to note the three causes to which heattributes old age: "As the World waxeth old, Men grow old withit: not by reason of the Age of the World, but because of thegreat Increase of living Creatures, which infect the very Air,that every way encompasseth us, and Through our Negligence inordering our Lives, and That great Ignorance of the Propertieswhich are in things conducing to Health, which might help adisordered way of Living, and might supply the defect of dueGovernment."

What would have been its fate if the mind of Europe had beenready for Roger Bacon's ferment, and if men had turned to theprofitable studies of physics, astronomy and chemistry instead ofwasting centuries over the scholastic philosophy and thesubtleties of Duns Scotus, Abelard and Thomas Aquinas? Who cansay? Make no mistake about the quality of these men--giants inintellect, who have had their place in the evolution of the race;but from the standpoint of man struggling for the mastery of thisworld they are like the members of Swift's famous college "busydistilling sunshine from cucumbers." I speak, of course, from theposition of the natural man, who sees for his fellows more hopefrom the experiments of Roger Bacon than from the disputations ofphilosophy on the "Instants, Familiarities, Quiddities andRelations," which so roused the scorn of Erasmus.

MEDIAEVAL MEDICAL STUDIES

IT will be of interest to know what studies were followed at amediaeval university. At Oxford, as at most of the continentaluniversities, there were three degrees, those of Bachelor,Licentiate and Doctor. The books read were the "Tegni" of Galen,the "Aphorisms" of Hippocrates, the "De Febribus" of Isaac andthe "Antidotarium" of Nicolaus Salernitanus: if a graduate inarts, six years' study in all was required, in other faculties,eight. One gets very full information on such matters from amost interesting book, "Une Chaire de Medecine au XVe Siecle," byDr. Ferrari (Paris, 1899). The University of Pavia was founded in1361, and like most of those in Italy was largely frequented byforeigners, who were arranged, as usual, according to theirnationalities; but the students do not appear to have controlledthe university quite so much as at Bologna. The documents of theFerrari family, on which the work is based, tell the story of oneof its members, who was professor at Pavia from 1432 to 1472. Oneis surprised at the range of studies in certain directions, andstill more at the absence of other subjects. A list is given ofthe teachers in medicine for the year 1433, twenty in all, andthere were special lectures for the morning, afternoon andevening. The subjects are medicine, practical medicine, physics,metaphysics, logic, astrology, surgery and rhetoric: verystriking is the omission of anatomy, which does not appear in thelist even in 1467. The salaries paid were not large, so thatmost of the teachers must have been in practice: four hundred andfive hundred florins was the maximum.

The dominance of the Arabians is striking. In 1467, special

lectures were given on the "Almansor" of Rhazes, and in thecatalogue of the Ferrari's library more than one half of thebooks are Arabian commentaries on Greek medicine. Still morestriking evidence of their influence is found in the text-book ofFerrari, which was printed in 1471 and had been circulatedearlier in MS. In it Avicenna is quoted more than 3000 times,Rhazes and Galen 1000, Hippocrates only 140 times. ProfessorFerrari was a man who played an important role in the university,and had a large consultation practice. You will be interested toknow what sort of advice he gave in special cases. I have therecord of an elaborate consultation written in his own hand, fromwhich one may gather what a formidable thing it was to fall intothe hands of a mediaeval physician. Signor John de Calabria had adigestive weakness of the stomach, and rheumatic cerebraldisease, combined with superfluous heat and dryness of the liverand multiplication of choler. There is first an elaboratediscussion on diet and general mode of life; then he proceeds todraw up certain light medicines as a supplement, but it must havetaken an extensive apothecary's shop to turn out the twenty-twoprescriptions designed to meet every possible contingency.

One of the difficulties in the early days of the universities wasto procure good MSS. In the Paris Faculty, the records of whichare the most complete in Europe, there is an inventory for theyear 1395 which gives a list of twelve volumes, nearly all byArabian authors.[25] Franklin gives an interesting incidentillustrating the rarity of medical MSS. at this period. LouisXI, always worried about his health, was anxious to have in hislibrary the works of Rhazes. The only copy available was in thelibrary of the medical school. The manuscript was lent, but onexcellent security, and it is nice to know that it was returned.

[25] Franklin: Recherches sur la Bibliotheque de la Faculte deMedecine de Paris, 1864.

It is said that one of the special advantages that Montpellierhad over Paris was its possession of so many important MSS.,particularly those of the Arabian writers. Many "Compendia" werewritten containing extracts from various writers, and no doubtthese were extensively copied and lent or sold to students. AtBologna and Padua, there were regulations as to the price ofthese MSS. The university controlled the production of them, andstationers were liable to fines for inaccurate copies. The trademust have been extensive in those early days, as Rashdallmentions that in 1323 there were twenty-eight sworn booksellersin Paris, besides keepers of bookstalls in the open air.

MEDIAEVAL PRACTICE

THE Greek doctrine of the four humors colored all the conceptionsof disease; upon their harmony alone it was thought that healthdepended. The four temperaments, sanguine, phlegmatic, biliousand melancholic, corresponded with the prevalence of thesehumors. The body was composed of certain so-called "naturals,"seven in number-- the elements, the temperaments, the humors, the

members or parts, the virtues or faculties, the operations orfunctions and the spirits. Certain "non-naturals," nine innumber, preserved the health of the body, viz.) air, food anddrink, movement and repose, sleeping and waking, excretion andretention, and the passions. Disease was due usually toalterations in the composition of the humors, and the indicationsfor treatment were in accordance with these doctrines. They wereto be evacuated, tenuated, cooled, heated, purged orstrengthened. This humoral doctrine prevailed throughout theMiddle Ages, and reached far into modern times--indeed, echoes ofit are still to be heard in popular conversations on the natureof disease.

The Arabians were famous for their vigor and resource in mattersof treatment. Bleeding was the first resort in a large majorityof all diseases. In the "Practice" of Ferrari there is scarcelya malady for which it is not recommended. All remedies weredirected to the regulation of the six non-naturals, and theyeither preserved health, cured the disease or did the opposite.The most popular medicines were derived from the vegetablekingdom, and as they were chiefly those recommended by Galen,they were, and still are, called by his name. Many importantmineral medicines were introduced by the Arabians, particularlymercury, antimony, iron, etc. There were in addition scores ofsubstances, the parts or products of animals, some harmless,others salutary, others again useless and disgusting. Minorsurgery was in the hands of the barbers, who performed all theminor operations, such as bleeding; the more importantoperations, few in number, were performed by surgeons.

ASTROLOGY AND DIVINATION

AT this period astrology, which included astronomy, waseverywhere taught. In the "Gouernaunce of Prynces, or Pryvete ofPryveties," translated by James Yonge, 1422,[26] there occurs thestatement: "As Galian the lull wies leche Saith and Isoder theGode clerk, hit witnessith that a man may not perfitely can thesciens and craft of Medissin but yef he be an astronomoure."

[26] Early English Text Society, Extra Series, No. LXXIV, p. 195,1898; Secreta Secretorum, Rawl. MS. B., 490.

We have seen how the practice of astrology spread from Babyloniaand Greece throughout the Roman Empire. It was carried on intothe Middle Ages as an active and aggressive cult, looked uponaskance at times by the Church, but countenanced by the courts,encouraged at the universities, and always by the public. In thecurriculum of the mediaeval university, astronomy made up withmusic, arithmetic and geometry the Quadrivium. In the earlyfaculties, astronomy and astrology were not separate, and atBologna, in the early fourteenth century, we meet with aprofessorship of astrology.[27] One of the duties of thissalaried professor, was to supply "judgements" gratis for thebenefit of enquiring students, a treacherous and delicateassignment, as that most distinguished occupant of the chair at

Bologna, Cecco d'Ascoli, found when he was burned at the stake in1357, a victim of the Florentine Inquisition.[28]

[27] Rashdall: Universities of Europe in the Middle Ages, Vol.I, p. 240.

[28] Rashdall, l.c., Vol. I, p. 244.--Rashdall also mentions thatin the sixteenth century at Oxford there is an instance of ascholar admitted to practice astrology. l.c., Vol. II, p. 458.

Roger Bacon himself was a warm believer in judicial astrology andin the influence of the planets, stars and comets on generation,disease and death.

Many of the stronger minds of the Renaissance broke away from thefollies of the subject. Thus Cornelius Agrippa in reply to therequest of a friar to consult the stars on his behalf says:[29]"Judicial astrology is nothing more than the fallacious guess ofsuperstitious men, who have founded a science on uncertain thingsand are deceived by it: so think nearly all the wise; as such itis ridiculed by some most noble philosophers; Christiantheologians reject it, and it is condemned by sacred councils ofthe Church. Yet you, whose office it is to dissuade others fromthese vanities, oppressed, or rather blinded by I know not whatdistress of mind, flee to this as to a sacred augur, and as ifthere were no God in Israel, that you send to inquire of the godof Ekron."

[29] H. Morley: The Life of Henry Cornelius Agrippa, London,1856, Vol. II, p. 138.

In spite of the opposition of the Church astrology held its own;many of the universities at the end of the fifteenth centurypublished almanacs, usually known as "Prognosticons," and thepractice was continued far into the sixteenth century. I showyou here an illustration. Rabelais, you may remember, whenphysician to the Hotel Dieu in Lyons, published almanacs for theyears 1533, 1535, 1541, 1546. In the title-page he called himself"Doctor of Medicine and Professor of Astrology," and theycontinued to be printed under his name until 1556. In thepreparation of these he must have had his tongue in his cheek, asin his famous "Pantagrueline Prognostication," in which, tosatisfy the curiosity of all good companions, he had turned overall the archives of the heavens, calculated the quadratures ofthe moon, hooked out all that has ever been thought by all theAstrophils, Hypernephilists, Anemophylakes, Uranopets andOmbrophori, and felt on every point with Empedocles.[30]

[30] Pantagrueline Prognostication, Rabelais, W. F. Smith'stranslation, 1893, Vol. II, p. 460.

Even physicians of the most distinguished reputation practisedjudicial astrology. Jerome Cardan was not above earning money bycasting horoscopes, and on this subject he wrote one of his most

popular books (De Supplemento Almanach, etc., 1543), in whichastronomy and astrology are mixed in the truly mediaeval fashion.He gives in it some sixty-seven nativities, remarkable for theevents they foretell, with an exposition. One of the accusationsbrought against him was that he had "attempted to subject to thestars the Lord of the stars and cast our Saviour'shoroscope."[31] Cardan professed to have abandoned a practicelooked upon with disfavor both by the Church and by theuniversities, but he returned to it again and again. I show herehis own horoscope. That remarkable character, Michael Servetus,the discoverer of the lesser circulation, when a fellow studentwith Vesalius at Paris, gave lectures upon judicial astrology,which brought him into conflict with the faculty; and the rarestof the Servetus works, rarer even than the "ChristianismiRestitutio," is the "Apologetica disceptatio pro astrologia," onecopy of which is in the Bibliotheque Nationale. Nor could thenew astronomy and the acceptance of the heliocentric viewsdislocate the popular belief. The literature of the seventeenthcentury is rich in astrological treatises dealing with medicine.

[31] De Thou, Lib. LXII, quoted by Morley in Life of JeromeCardan, Vol. II, p. 294.

No one has ever poured such satire upon the mantic arts as didRabelais in chapter twenty-five of the third book of"Pantagruel." Panurge goes to consult Her Trippa--the famousCornelius Agrippa, whose opinion of astrology has already beenquoted, but who nevertheless, as court astrologer to Louise ofSavoy, had a great contemporary reputation. After lookingPanurge in the face and making conclusions by metoposcopy andphysiognomy, he casts his horoscope secundum artem, then, takinga branch of tamarisk, a favorite tree from which to get thedivining rod, he names some twenty-nine or thirty mantic arts,from pyromancy to necromancy, by which he offers to predict hisfuture. While full of rare humor, this chapter throws aninteresting light on the extraordinary number of modes ofdivination that have been employed. Small wonder that Panurgerepented of his visit! I show here the title-page of a popularbook by one of the most famous of the English astrologicalphysicians, Nicholas Culpeper.

Never was the opinion of sensible men on this subject betterexpressed than by Sir Thomas Browne:[32] "Nor do we hereby rejector condemn a sober and regulated Astrology; we hold there is moretruth therein than in ASTROLOGERS; in some more than many allow,yet in none so much as some pretend. We deny not the influence ofthe Starres, but often suspect the due application thereof; forthough we should affirm that all things were in all things; thatHeaven were but Earth Celestified, and earth but Heaventerrestrified, or that each part above had an influence upon itsdivided affinity below; yet how to single out these relations,and duly to apply their actions, is a work ofttimes to beeffected by some revelation, and Cabala from above, rather thanany Philosophy, or speculation here below."

[32] Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap.

XIII. (Wilkin's ed., Vol. III, p. 84.)

As late as 1699, a thesis was discussed at the Paris Faculty,"Whether comets were harbingers of disease," and in 1707 theFaculty negatived the question propounded in a thesis, "Whetherthe moon had any sway on the human body."

The eighteenth and nineteenth centuries saw, among intelligentmen, a progressive weakening of the belief in the subject; butnot even the satire of Swift, with his practical joke inpredicting and announcing the death of the famous almanac maker,nor contemptuous neglect of the subject of late years sufficed todispel the belief from the minds of the public. Garth in theDispensary (1699) satirizes the astrological practitioners of hisday:

The Sage in Velvet Chair, here lolls at EaseTo promise future Health for present FeesThen as from Tripod solemn Sham revealsAnd what the Stars know nothing of foretell. (Canto ii.)

The almanacs of Moore and Zadkiel continue to be published, andremain popular. In London, sandwich men are to be met withcarrying advertisements of Chaldeans and Egyptians who offer totell your fortune by the stars. Even in this country, astrologyis still practiced to a surprising extent if one may judge fromadvertisements in certain papers, and from publications whichmust have a considerable sale. Many years ago, I had as a patientan estimable astrologer, whose lucrative income was derived fromgiving people astral information as to the rise and fall ofstocks. It is a chapter in the vagaries of the human mind that isworth careful study.[33] Let me commend to your reading thesympathetic story called "A Doctor of Medicine" in the "Rewardsand Fairies" of Kipling. The hero is Nicholas Culpeper, Gent.,whose picture is here given. One stanza of the poem at the endof the story, "Our Fathers of Old," may be quoted:

Wonderful tales had our fathers of old-- Wonderful tales of the herbs and the stars--The Sun was Lord of the Marigold, Basil and Rocket belonged to Mars.Pat as a sum in division it goes-- (Every plant had a star bespoke)-- Who but Venus should govern the Rose? Who but Jupiter own the Oak? Simply and gravely the facts are told In the wonderful books of our fathers of old.

[33] It is not generally known that Stonewall Jackson practicedastrology. Col. J. W. Revere in "Keel and Saddle" (Boston, 1872)tells of meeting Jackson in 1852 on a Mississippi steamer andtalking with him on the subject. Some months later, Reverereceived a letter from Jackson enclosing his (Revere's)horoscope. There was a "culmination of the malign aspect duringthe first days of May, 1863--both will be exposed to a commondanger at the time indicated." At the battle of

Chancellorsville, May 9, 1863, Revere saw Jackson mortallywounded!

James J. Walsh of New York has written a book of extraordinaryinterest called "The Thirteenth, Greatest of Centuries." I havenot the necessary knowledge to say whether he has made out hiscase or not for art and for literature. There was certainly agreat awakening and, inspired by high ideals, men turned with atrue instinct to the belief that there was more in life thancould be got out of barren scholastic studies. With many of thestrong men of the period one feels the keenest mental sympathy.Grosseteste, the great Clerk of Lincoln, as a scholar, a teacherand a reformer, represents a type of mind that could grow only infruitful soil. Roger Bacon may be called the first of themoderns--certainly the first to appreciate the extraordinarypossibilities which lay in a free and untrammelled study ofnature. A century which could produce men capable of building theGothic cathedrals may well be called one of the great epochs inhistory, and the age that produced Dante is a golden one inliterature. Humanity has been the richer for St. Francis; andAbelard, Albertus and Aquinas form a trio not easy to match, intheir special departments, either before or after. But inscience, and particularly in medicine, and in the advance of anoutlook upon nature, the thirteenth century did not help man verymuch. Roger Bacon was "a voice crying in the wilderness," andnot one of the men I have picked out as specially typical of theperiod instituted any new departure either in practice or inscience. They were servile followers, when not of the Greeks, ofthe Arabians. This is attested by the barrenness of the centuryand a half that followed. One would have thought that thestimulus given by Mundinus to the study of anatomy would haveborne fruit, but little was done in science during the two and ahalf centuries that followed the delivery of his lectures andstill less in the art. While William of Wykeham was buildingWinchester Cathedral and Chaucer was writing the CanterburyTales, John of Gaddesden in practice was blindly following blindleaders whose authority no one dared question.

The truth is, from the modern standpoint the thirteenth was notthe true dawn brightening more and more unto the perfect day, buta glorious aurora which flickered down again into the arcticnight of mediaevalism.

To sum up--in medicine the Middle Ages represent a restatementfrom century to century of the facts and theories of the Greeksmodified here and there by Arabian practice. There was, inFrancis Bacon's phrase, much iteration, small addition. Theschools bowed in humble, slavish submission to Galen andHippocrates, taking everything from them but their spirit andthere was no advance in our knowledge of the structure orfunction of the body. The Arabians lit a brilliant torch fromGrecian lamps and from the eighth to the eleventh centuries theprofession reached among them a position of dignity andimportance to which it is hard to find a parallel in history.

CHAPTER IV

THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY

THE "reconquest of the classic world of thought was by far themost important achievement of the fifteenth and sixteenthcenturies. It absorbed nearly the whole mental energy of theItalians.... The revelation of what men were and what theywrought under the influence of other faiths and other impulses,in distant ages with a different ideal for their aim, not onlywidened the narrow horizon of the Middle Ages, but it alsorestored self-confidence to the reason of humanity."[1]

[1] J. A. Symonds: The Renaissance in Italy; the Revival ofLearning, 1877, p. 52.

Everywhere throughout the Middle Ages learning was the handmaidof theology. Even Roger Bacon with his strong appeal for a newmethod accepted the dominant mediaeval conviction--that all thesciences did but minister to their queen, Theology. A new spiritentered man's heart as he came to look upon learning as a guideto the conduct of life. A revolution was slowly effected in theintellectual world. It is a mistake to think of the Renaissanceas a brief period of sudden fruitfulness in the North Italiancities. So far as science is concerned, the thirteenth centurywas an aurora followed by a long period of darkness, but thefifteenth was a true dawn that brightened more and more unto theperfect day. Always a reflex of its period, medicine joinedheartily though slowly in the revolt against mediaevalism. Howslowly I did not appreciate until recently. Studying the earliestprinted medical works to catch the point of view of the men whowere in the thick of the movement up to 1480-- which may be takento include the first quarter of a century of printing-- one getsa startling record. The mediaeval mind still dominates: of thesixty-seven authors of one hundred and eighty-two editions ofearly medical books, twenty-three were men of the thirteenth andfourteenth centuries, thirty men of the fifteenth century, eightwrote in Arabic, several were of the School of Salernum, and onlysix were of classical antiquity, viz., Pliny (first 1469),Hippocrates (1473) [Hain [*]7247], Galen (1475) [Hain 7237],Aristotle (1476), Celsus (1478), and Dioscorides (1478).[**]

[*] This asterisk is used by Hain to indicate that he had seen acopy.--Ed.

[**] Data added to a manuscript taken from the author's summaryon "Printed Medical Books to 1480" in Transactions of theBibliographical Society, London, 1916, XIII, 5-8, revised fromits "News-Sheet" (February, 1914). "Of neither Hippocrates norGalen is there an early edition; but in 1473 at Pavia appeared anexposition of the Aphorisms of Hippoerates, and in 1475 at Paduaan edition of the Tegni or Notes of Galen." Ibid., p. 6.Osler's unfinished Illustrated Monograph on this subject is nowbeing printed for the Society of which he was President.--Ed.

The medical profession gradually caught the new spirit. It hasbeen well said that Greece arose from the dead with the NewTestament in the one hand and Aristotle in the other. There wasawakened a perfect passion for the old Greek writers, and with ita study of the original sources, which had now become availablein many manuscripts. Gradually Hippocrates and Galen came totheir own again. Almost every professor of medicine became astudent of the MSS. of Aristotle and of the Greek physicians, andbefore 1530 the presses had poured out a stream of editions. Awave of enthusiasm swept over the profession, and the bestenergies of its best minds were devoted to a study of theFathers. Galen became the idol of the schools. A strongrevulsion of feeling arose against the Arabians, and Avicenna,the Prince, who had been clothed with an authority only a littleless than divine, became anathema. Under the leadership of theMontpellier School, the Arabians made a strong fight, but it wasa losing battle all along the line. This group of medicalhumanists--men who were devoted to the study of the oldhumanities, as Latin and Greek were called-- has had a great andbeneficial influence upon the profession. They were for the mostpart cultivated gentlemen with a triple interest--literature,medicine and natural history. How important is the part theyplayed may be gathered from a glance at the "Lives" given byBayle in his "Biographic Medicale" (Paris, 1855) between theyears 1500 and 1575. More than one half of them had translatedor edited works of Hippocrates or Galen; many of them had madeimportant contributions to general literature, and a largeproportion of them were naturalists: Leonicenus, Linacre,Champier, Fernel, Fracastorius, Gonthier, Caius, J. Sylvius,Brasavola, Fuchsius, Matthiolus, Conrad Gesner, to mention onlythose I know best, form a great group. Linacre edited Greek worksfor Aldus, translated works of Galen, taught Greek at Oxford,wrote Latin grammars and founded the Royal College ofPhysicians.[*] Caius was a keen Greek scholar, an ardent studentof natural history, and his name is enshrined as co-founder ofone of the most important of the Cambridge colleges. Gonthier,Fernel, Fuchs and Mattioli were great scholars and greaterphysicians. Champier, one of the most remarkable of the group,was the founder of the Hotel Dieu at Lyons, and author of booksof a characteristic Renaissance type and of singularbibliographical interest. In many ways greatest of all wasConrad Gesner, whose mors inopinata at forty-nine, bravelyfighting the plague, is so touchingly and tenderly mourned by hisfriend Caius.[2] Physician, botanist, mineralogist, geologist,chemist, the first great modern bibliographer, he is the veryembodiment of the spirit of the age.[2a] On the flyleaf of mycopy of the "Bibliotheca Universalis" (1545), is written a finetribute to his memory. I do not know by whom it is, but I do knowfrom my reading that it is true:

[*] Cf. Osler: Thomas Linacre, Cambridge University Press,1908.--Ed.

[2] Joannis Caii Britanni de libris suis, etc., 1570.

[2a] See J. C. Bay: Papers Bibliog. Soc. of America, 1916, X,

No. 2, 53-86.

"Conrad Gesner, who kept open house there for all learned men whocame into his neighborhood. Gesner was not only the bestnaturalist among the scholars of his day, but of all men of thatcentury he was the pattern man of letters. He was faultless inprivate life, assiduous in study, diligent in maintainingcorrespondence and good-will with learned men in all countries,hospitable--though his means were small-- to every scholar thatcame into Zurich. Prompt to serve all, he was an editor of othermen's volumes, a writer of prefaces for friends, a suggestor toyoung writers of books on which they might engage themselves, anda great helper to them in the progress of their work. But still,while finding time for services to other men, he could produce asmuch out of his own study as though he had no part in the lifebeyond its walls."

A large majority of these early naturalists and botanists werephysicians.[3] The Greek art of observation was revived in astudy of the scientific writings of Aristotle, Theophrastus andDioscorides and in medicine, of Hippocrates and of Galen, all inthe Greek originals. That progress was at first slow was due inpart to the fact that the leaders were too busy scraping theArabian tarnish from the pure gold of Greek medicine andcorrecting the anatomical mistakes of Galen to bother much abouthis physiology or pathology. Here and there among the greatanatomists of the period we read of an experiment, but it was theart of observation, the art of Hippocrates, not the science ofGalen, not the carefully devised experiment to determinefunction, that characterized their work. There was indeed everyreason why men should have been content with the physiology andpathology of that day, as, from a theoretical standpoint, it wasexcellent. The doctrine of the four humors and of the natural,animal and vital spirits afforded a ready explanation for thesymptoms of all diseases, and the practice of the day wasadmirably adapted to the theories. There was no thought of, nodesire for, change. But the revival of learning awakened in menat first a suspicion and at last a conviction that the ancientshad left something which could be reached by independentresearch, and gradually the paralytic-like torpor passed away.

[3] Miall: The Early Naturalists, London, 1912.

The sixteenth and seventeenth centuries did three things inmedicine-- shattered authority, laid the foundation of anaccurate knowledge of the structure of the human body anddemonstrated how its functions should be studiedintelligently--with which advances, as illustrating this period,may be associated the names of Paracelsus, Vesalius and Harvey.

PARACELSUS

PARACELSUS is "der Geist der stets verneint." He roused menagainst the dogmatism of the schools, and he stimulated

enormously the practical study of chemistry. These are his greatmerits, against which must be placed a flood of hermetical andtranscendental medicine, some his own, some foisted in his name,the influence of which is still with us.

"With what judgment ye judge it shall be judged to you again" isthe verdict of three centuries on Paracelsus. In return forunmeasured abuse of his predecessors and contemporaries he hasbeen held up to obloquy as the arch-charlatan of history. We havetaken a cheap estimate of him from Fuller and Bacon, and from ahost of scurrilous scribblers who debased or perverted hiswritings. Fuller[4] picked him out as exemplifying the drunkenquack, whose body was a sea wherein the tide of drunkenness wasever ebbing and flowing-- "He boasted that shortly he would orderLuther and the Pope, as well as he had done Galen andHippocrates. He was never seen to pray, and seldome came toChurch. He was not onely skilled in naturall Magick (the utmostbounds whereof border on the suburbs of hell) but is charged toconverse constantly with familiars. Guilty he was of all vicesbut wantonnesse: . . . "

[4] Fuller: The Holy and Profane State, Cambridge, 1642, p. 56.

Francis Bacon, too, says many hard things of him.[5]

[5] Bacon: Of the Proficience and Advancement of Learning, Bk.II, Pickering ed., London, 1840, p. 181. Works, Spedding ed.,III, 381.

To the mystics, on the other hand, he is Paracelsus the Great,the divine, the most supreme of the Christian magi, whosewritings are too precious for science, the monarch of secrets,who has discovered the Universal Medicine. This is illustratedin Browning's well-known poem "Paracelsus," published when he wasonly twenty-one; than which there is no more pleasant picture inliterature of the man and of his aspirations. His was a"searching and impetuous soul" that sought to win from naturesome startling secret--". . . a tincture of force to flush oldage with youth, or breed gold, or imprison moonbeams till theychange to opal shafts!" At the same time with that capacity forself-deception which characterizes the true mystic he sought tocast

Light on a darkling race; save for that doubt,I stood at first where all aspire at lastTo stand: the secret of the world was mine.I knew, I felt (perception unexpressed,Uncomprehended by our narrow thought,But somehow felt and known in every shiftAnd change in the spirit,--nay, in every poreOf the body, even)--what God is, what we are,What life is--. . .[6]

[6] Robert Browning: Paracelsus, closing speech.

Much has been done of late to clear up his story and hischaracter. Professor Sudhoff, of Leipzig, has made an exhaustivebibliographical study of his writings,[7] there have been recentmonographs by Julius Hartmann, and Professors Franz and KarlStrunz,[8] and a sympathetic summary of his life and writings hasbeen published by the late Miss Stoddart.[9] Indeed there is atpresent a cult of Paracelsus. The hermetic and alchemicalwritings are available in English in the edition of A. E. Waite,London, 1894. The main facts of his life you can find in all thebiographies. Suffice it here to say that he was born atEinsiedeln, near Zurich, in 1493, the son of a physician, fromwhom he appears to have had his early training both in medicineand in chemistry. Under the famous abbot and alchemist,Trithemiusof Wurzburg, he studied chemistry and occultism. Afterworking in the mines at Schwatz he began his wanderings, duringwhich he professes to have visited nearly all the countries inEurope and to have reached India and China. Returning to Germanyhe began a triumphal tour of practice through the German cities,always in opposition to the medical faculty, and constantly introuble. He undoubtedly performed many important cures, and wasthought to have found the supreme secret of alchemistry. In thepommel of his sword he was believed to carry a familiar spirit.So dominant was his reputation that in 1527 he was called to thechair of physic in the University of Basel. Embroiled inquarrels after his first year he was forced to leave secretly,and again began his wanderings through German cities, working,quarrelling, curing, and dying prematurely at Saltzburg in 1541--one of the most tragic figures in the history of medicine.

[7] Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894,1899.

[8] R. Julius Hartmann: Theophrast von Hohenheim, Berlin, 1904;ditto, Franz Strunz,Leipzig, 1903.

[9] Anna M. Stoddart: The Life of Paracelsus, London, JohnMurray, 1911.

Paracelsus is the Luther of medicine, the very incarnation of thespirit of revolt. At a period when authority was paramount, andmen blindly followed old leaders, when to stray from the beatentrack in any field of knowledge was a damnable heresy, he stoodout boldly for independent study and the right of privatejudgment. After election to the chair at Basel he at onceintroduced a startling novelty by lecturing in German. He hadcaught the new spirit and was ready to burst all bonds both inmedicine and in theology. He must have startled the old teachersand practitioners by his novel methods."On June 5, 1527, heattached a programme of his lectures to the black-board of theUniversity inviting all to come to them. It began by greeting allstudents of the art of healing. He proclaimed its lofty andserious nature, a gift of God to man, and the need of developingit to new importance and to new renown. This he undertook to do,not retrogressing to the teaching of the ancients, butprogressing whither nature pointed, through research into nature,where he himself had discovered and had verified by prolonged

experiment and experience.He was ready to oppose obedience to oldlights as if they were oracles from which one did not dare todiffer. Illustrious doctor smight be graduated from books, butbooks made not a single physician.[10] Neither graduation, norfluency, nor the knowledge of old languages, nor the reading ofmany books made a physician, but the knowledge of thingsthemselves and their properties. The business of a doctor was toknow the different kinds of sicknesses, their causes,theirsymptoms and their right remedies. This he would teach, for hehad won this knowledge through experience, the greatest teacher,and with much toil. He would teach it as he had learned it, andhis lectures would be founded on works which he had composedconcerning inward and external treatment, physic andsurgery."[11] Shortly afterwards, at the Feast of St. John, thestudents had a bonfire in front of the university. Paracelsuscame out holding in his hands the "Bible of medicine," Avicenna's"Canon," which he flung into the flames saying: "Into St. John'sfire so that all misfortune may go into the air with the smoke."It was, as he explained afterwards, a symbolic act: "What hasperished must go to the fire; it is no longer fit for use: whatis true and living, that the fire cannot burn." With abundantconfidence in his own capacity he proclaimed himself thelegitimate monarch, the very Christ of medicine. "You shallfollow me," cried he, "you, Avicenna, Galen, Rhasis, Montagnana,Mesues; you, Gentlemen of Paris, Montpellier, Germany, Cologne,Vienna, and whomsoever the Rhine and Danube nourish; you whoinhabit the isles of the sea; you, likewise, Dalmatians,Athenians; thou, Arab; thou, Greek; thou, Jew; all shall followme, and the monarchy shall be mine."[12]

[10] And men have oft grown old among their books To die case hardened in their ignorance.

--Paracelsus, Browning.

[11] Anna M. Stoddart: Life of Paracelsus, London, 1911, pp.95-96.

[12] Browning's Paracelsus, London, 1835, p. 206 (note).

This first great revolt against the slavish authority of theschools had little immediate effect, largely on account of thepersonal vagaries of the reformer--but it made men think.Paracelsus stirred the pool as had not been done for fifteencenturies.

Much more important is the relation of Paracelsus to the newchemical studies, and their relation to practical medicine.Alchemy, he held, "is to make neither gold nor silver: its useis to make the supreme sciences and to direct them againstdisease." He recognized three basic substances, sulphur, mercuryand salt, which were the necessary ingredients of all bodiesorganic or inorganic. They were the basis of the threeprinciples out of which the Archaeus, the spirit of nature,formed all bodies. He made important discoveries in chemistry;

zinc, the various compounds of mercury, calomel, flowers ofsulphur, among others, and he was a strong advocate of the use ofpreparations of iron and antimony. In practical pharmacy he hasperhaps had a greater reputation for the introduction of atincture of opium--labdanum or laudanum--with which he effectedmiraculous cures, and the use of which he had probably learned inthe East.

Through Paracelsus a great stimulus was given to the study ofchemistry and pharmacy, and he is the first of the moderniatro-chemists. In contradistinction to Galenic medicines, whichwere largely derived from the vegetable kingdom, from this timeon we find in the literature references to spagyric medicines anda "spagyrist" was a Paracelsian who regarded chemistry as thebasis of all medical knowledge.

One cannot speak very warmly of the practical medical writings ofParacelsus. Gout, which may be taken as the disease upon whichhe had the greatest reputation, is very badly described, and yethe has one or two fruitful ideas singularly mixed with mediaevalastrology; but he has here and there very happy insights, aswhere he remarks "nec praeter synoviam locqum alium ullum podagraoccupat."[13] In the tract on phlebotomy I see nothing modern,and here again he is everywhere dominated by astrologicalideas--"Sapiens dominatur astris."

[13 Geneva ed., 1658, Vol. I, p. 613.

As a protagonist of occult philosophy, Paracelsus has had a moreenduring reputation than as a physician. In estimating hisposition there is the great difficulty referred to by Sudhoff indetermining which of the extant treatises are genuine. In the twovolumes issued in English by Waite in 1894, there is much that isdifficult to read and to appreciate from our modern standpoint.In the book "Concerning Long Life" he confesses that his methodand practice will not be intelligible to common persons and thathe writes only for those whose intelligence is above the average.To those fond of transcendental studies they appeal and areperhaps intelligible. Everywhere one comes across shrewd remarkswhich prove that Paracelsus had a keen belief in theall-controlling powers of nature and of man's capacity to makethose powers operate for his own good: "the wise man rulesNature, not Nature the wise man." "The difference between theSaint and the Magus is that the one operates by means of God, andthe other by means of Nature." He had great faith in nature andthe light of nature, holding that man obtains from natureaccording as he believes. His theory of the three principlesappears to have controlled his conception of everything relatingto man, spiritually, mentally and bodily; and his threefoldgenera of disease corresponded in some mysterious way with thethree primary substances, salt, sulphur and mercury.

How far he was a believer in astrology, charms and divination itis not easy to say. From many of the writings in his collectedworks one would gather, as I have already quoted, that he was a

strong believer. On the other hand, in the "Paramirum," he says:"Stars control nothing in us, suggest nothing, incline tonothing, own nothing; they are free from us and we are free fromthem" (Stoddart, p. 185). The Archaeus, not the stars, controlsman's destiny. "Good fortune comes from ability, and abilitycomes from the spirit" (Archaeus).

No one has held more firmly the dualistic conception of thehealing art. There are two kinds of doctors; those who healmiraculously and those who heal through medicine. Only he whobelieves can work miracles. The physician has to accomplish thatwhich God would have done miraculously, had there been faithenough in the sick man (Stoddart, p. 194). He had the Hippocraticconception of the "vis medicatrix naturae"-- no one keener sincethe days of the Greeks. Man is his own doctor and finds properhealing herbs in his own garden: the physician is in ourselves,in our own nature are all things that we need: and speaking ofwounds, with singular prescience he says that the treatmentshould be defensive so that no contingency from without couldhinder Nature in her work (Stoddart, p. 213).

Paracelsus expresses the healing powers of nature by the word"mumia," which he regarded as a sort of magnetic influence orforce, and he believed that anyone possessing this could arrestor heal disease in others. As the lily breaks forth in invisibleperfume, so healing influences may pass from an invisible body.Upon these views of Paracelsus was based the theory of thesympathetic cure of disease which had an extraordinary vogue inthe late sixteenth and seventeenth centuries, and which is notwithout its modern counterpart.

In the next century, in Van Helmont we meet with the Archaeuseverywhere presiding, controlling and regulating the animate andinanimate bodies, working this time through agents, localferments. The Rosicrucians had their direct inspiration from hiswritings, and such mystics as the English Rosicrucian Fludd werestrong Paracelsians.[14]

[14] Robert Fludd, the Mystical Physician, British MedicalJournal, London, 1897, ii, 408.

The doctrine of contraries drawn from the old Greek philosophy,upon which a good deal of the treatment of Hippocrates and Galenwas based--dryness expelled by moisture, cold by heat, etc.--wasopposed by Paracelsus in favor of a theory of similars, uponwhich the practice of homeopathy is based. This really arosefrom the primitive beliefs, to which I have already referred asleading to the use of eyebright in diseases of the eye, andcyclamen in diseases of the ear because of its resemblance tothat part; and the Egyptian organotherapy had the samebasis,--spleen would cure spleen, heart, heart, etc. In thesixteenth and seventeenth centuries these doctrines of sympathiesand antipathies were much in vogue. A Scotchman, SylvesterRattray, edited in the "Theatrum Sympatheticum"[15] all thewritings upon the sympathies and antipathies of man with animal,vegetable and mineral substances, and the whole art of physics

was based on this principle.

[15] Rattray: Theatrum Sympatheticum, Norimberge, MDCLXII.

Upon this theory of "mumia," or magnetic force, the sympatheticcure of disease was based. The weapon salve, the sympatheticointment, and the famous powder of sympathy were the instrumentsthrough which it acted. The magnetic cure of wounds became thevogue. Van Helmont adopted these views in his famous treatise "DeMagnetica Vulnerum Curatione,"[16] in which he asserted thatcures were wrought through magnetic influence. How close theycame to modern views of wound infection may be judged from thefollowing: "Upon the solution of Unity in any part the ambientair . . . repleted with various evaporations or aporrhoeas ofmixt bodies, especially such as are then suffering the act ofputrefaction, violently invadeth the part and thereuponimpresseth an exotic miasm or noxious diathesis, which disposeththe blood successively arriving at the wound, to putrefaction, bythe intervention of fermentation." With his magnetic sympathy,Van Helmont expressed clearly the doctrine of immunity and thecure of disease by immune sera: "For he who has once recoveredfrom that disease hath not only obtained a pure balsaamicalblood, whereby for the future he is rendered free from anyrecidivation of the same evil, but also infallibly cures the sameaffection in his neighbour . . . and by the mysterious power ofMagnetism transplants that balsaam and conserving quality intothe blood of another." He was rash enough to go further and saythat the cures effected by the relics of the saints were also dueto the same cause--a statement which led to a great discussionwith the theologians and to Van Helmont's arrest for heresy, andsmall wonder, when he makes such bold statements as "Let theDivine enquire only concerning God, the Naturalist concerningNature," and "God in the production of miracles does for the mostpart walk hand in hand with Nature."

[16] An English translation by Walter Charleton appeared in 1650,entitled "A Ternary of Paradoxes."

That wandering genius, Sir Kenelm Digby, did much to popularizethis method of treatment by his lecture on the "Powder ofSympathy."[17] His powder was composed of copperas alone or mixedwith gum tragacanth. He regarded the cure as effected through thesubtle influence of the sympathetic spirits or, as Highmore says,by "atomicall energy wrought at a distance," and the remedy couldbe applied to the wound itself, or to a cloth soaked in the bloodor secretions, or to the weapon that caused the wound. Onefactor leading to success may have been that in the directionswhich Digby gave for treating the wound (in the celebrated caseof James Howell, for instance), it was to be let alone and keptclean. The practice is alluded to very frequently by the poets.In the "Lay of the Last Minstrel" we find the following:

[17 French edition, 1668, English translation, same year. For adiscussion on the author of the weapon salve see Van Helmont, whogives the various formulas. Highmore (1651) says the "powder is

a Zaphyrian salt calcined by a celestial fire operating in Leoand Cancer into a Lunar complexion."

But she has ta'en the broken lance, And wash'd it from the clotted gore, And salved the splinter o'er and o'er. William of Deloraine, in trance, Whene'er she turn'd it round and round, Twisted, as if she gall'd his wound, Then to her maidens she did say, That he should be whole man and sound,

(Canto iii, xxiii.)

and in Dryden's "Tempest" (V, 1) Ariel says:

Anoint the Sword which pierc'd him with the Weapon-Salve, And wrap it close from Air till I have time To visit him again.

From Van Helmont comes the famous story of the new nose thatdropped off in sympathy with the dead arm from which it wastaken, and the source of the famous lines of Hudibras. As I havenot seen the original story quoted of late years it may be worthwhile to give it: "A certain inhabitant of Bruxels, in a combathad his nose mowed off, addressed himself to Tagliacozzus, afamous Chirurgein, living at Bononia, that he might procure a newone; and when he feared the incision of his own arm, he hired aPorter to admit it, out of whose arm, having first given thereward agreed upon, at length he dig'd a new nose. About thirteenmoneths after his return to his own Countrey, on a sudden theingrafted nose grew cold, putrified, and within few days dropsoff. To those of his friends that were curious in the explorationof the cause of this unexpected misfortune, it was discovered,that the Porter expired, neer about the same punctilio of time,wherein the nose grew frigid and cadaverous. There are at Bruxelsyet surviving,some of good repute, that were eye-witnesses ofthese occurrences."[18]

[18] Charleton: Of the Magnetic Cure of Wounds, London, 1650, p.13.

Equally in the history of science and of medicine, 1542 is astarred year, marked by a revolution in our knowledge alike ofMacrocosm and Microcosm. In Frauenburg, the town physician and acanon, now nearing the Psalmist limit and his end, had sent tothe press the studies of a lifetime--"De revolutionibus orbiumcoelestium." It was no new thought, no new demonstration thatCopernicus thus gave to his generation. Centuries before, men ofthe keenest scientific minds from Pythagoras on had worked out aheliocentric theory, fully promulgated by Aristarchus, and verygenerally accepted by the brilliant investigators of theAlexandrian school; but in the long interval, lapped in Orientallethargy, man had been content to acknowledge that the heavens

declare the glory of God and that the firmament sheweth hishandiwork. There had been great astronomers before Copernicus.In the fifteenth century Nicholas of Cusa and Regiomontanus hadhinted at the heliocentric theory; but 1512 marks an epoch in thehistory of science, since for all time Copernicus put the problemin a way that compelled acquiescence.

Nor did Copernicus announce a truth perfect and complete, not tobe modified, but there were many contradictions and lacunae whichthe work of subsequent observers had to reconcile and fill up.For long years Copernicus had brooded over the great thoughtswhich his careful observation had compelled. We can imagine thetouching scene in the little town when his friend Osianderbrought the first copy of the precious volume hot from the press,a well enough printed book. Already on his deathbed, strickenwith a long illness, the old man must have had doubts how hiswork would be received, though years before Pope Clement VII hadsent him encouraging words. Fortunately death saved him from the"rending" which is the portion of so many innovators anddiscoverers. His great contemporary reformer, Luther, expressedthe view of the day when he said the fool will turn topsy-turvythe whole art of astronomy; but the Bible says that Joshuacommanded the Sun to stand still, not the Earth. The scholarlyMelanchthon, himself an astronomer, thought the book so godlessthat he recommended its suppression (Dannemann, Grundriss). Thechurch was too much involved in the Ptolemaic system to acceptany change and it was not until 1822 that the works of Copernicuswere removed from the Index.

VESALIUS

THE same year, 1542, saw a very different picture in thefar-famed city of Padua, "nursery of the arts." The centralfigure was a man not yet in the prime of life, and justly full ofits pride, as you may see from his portrait. Like Aristotle andHippocrates cradled and nurtured in an AEsculapian family,Vesalius was from his childhood a student of nature, and was nowa wandering scholar, far from his Belgian home. But in Italy hehad found what neither Louvain nor Paris could give, freedom inhis studies and golden opportunities for research in anatomy.What an impression he must have made on the student body at Paduamay be judged from the fact that shortly after his graduation inDecember, 1537, at the age of twenty-four, he was elected to thechair of anatomy and surgery. Two things favored him--aninsatiate desire to see and handle for himself the parts of thehuman frame, and an opportunity, such as had never before beenoffered to the teacher, to obtain material for the study of humananatomy. Learned with all the learning of the Grecians and of theArabians, Vesalius grasped, as no modern before him had done, thecardinal fact that to know the human machine and its working, itis necessary first to know its parts--its fabric.

To appreciate the work of this great man we must go back in abrief review of the growth of the study of anatomy.

Among the Greeks only the Alexandrians knew human anatomy. What

their knowledge was we know at second hand, but the evidence isplain that they knew a great deal. Galen's anatomy wasfirst-class and was based on the Alexandrians and on his studiesof the ape and the pig. We have already noted how much superiorwas his osteology to that of Mundinus. Between the Alexandriansand the early days of the School of Salernum we have no record ofsystematic dissections of the human body. It is even doubtful ifthese were permitted at Salernum. Neuburger states that theinstructions of Frederick II as to dissections were merelynominal.

How atrocious was the anatomy of the early Middle Ages may begathered from the cuts in the works of Henri de Mondeville. Inthe Bodleian Library is a remarkable Latin anatomical treatise ofthe late thirteenth century, of English provenance, oneillustration from which will suffice to show the ignorance of theauthor. Mundinus of Bologna, one of the first men in the MiddleAges to study anatomy from the subject, was under the strongdomination of the Arabians, from whom he appears to have receiveda very imperfect Galenic anatomy. From this date we meet withoccasional dissections at various schools, but we have seen thatin the elaborate curriculum of the University of Padua in themiddle of the fifteenth century there was no provision for thestudy of the subject. Even well into the sixteenth centurydissections were not common, and the old practice was followed ofholding a professorial discourse, while the butcher, or barbersurgeon, opened the cavities of the body. A member of a famousBasel family of physicians, Felix Plater, has left us in hisautobiography[19] details of the dissections he witnessed atMontpellier between November 14, 1552, and January 10, 1557, onlyeleven in number. How difficult it was at that time to getsubjects is shown by the risks they ran in "body-snatching"expeditions, of which he records three.

[19] There is no work from which we can get a better idea of thelife of the sixteenth-century medical student and of the style ofeducation and of the degree ceremonies, etc. Cumston has givenan excellent summary of it (Johns Hopkins Hospital Bulletin,1912, XXIII, 105-113).

And now came the real maker of modern anatomy. Andreas Vesaliushad a good start in life. Of a family long associated with theprofession, his father occupied the position of apothecary toCharles V, whom he accompanied on his journeys and campaigns.Trained at Louvain, he had, from his earliest youth, an ardentdesire to dissect, and cut up mice and rats, and even cats anddogs. To Paris, the strong school of the period, he went in 1533,and studied under two men of great renown, Jacob Sylvius andGuinterius. Both were strong Galenists and regarded the Masteras an infallible authority. He had as a fellow prosector, underthe latter, the unfortunate Servetus. The story of his troublesand trials in getting bones and subjects you may read in Roth's"Life."[20] Many interesting biographical details are also to befound in his own writings. He returned for a time to Louvain,and here he published his first book, a commentary on the"Almansor" of Rhazes, in 1537.

[20] M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. Anexcellent account of Vesalius and his contemporaries is given byJames Moores Ball in his superbly printed Andreas Vesalius, theReformer of Anatomy, St. Louis, 1910.

Finding it difficult, either in Paris or Louvain, to pursue hisanatomical studies, he decided to go to Italy where, at Veniceand Padua, the opportunities were greater. At Venice, heattended the practice of a hospital (now a barracks) which was incharge of the Theatiner Order. I show you a photograph of thebuilding taken last year. And here a strange destiny brought twomen together. In 1537, another pilgrim was working in Venicewaiting to be joined by his six disciples. After long years ofprobation, Ignatius Loyola was ready to start on the conquest ofa very different world. Devoted to the sick and to the poor, heattached himself to the Theatiner Order, and in the wards of thehospital and the quadrangle, the fiery, dark-eyed, little Basquemust frequently have come into contact with the sturdy youngBelgian, busy with his clinical studies and his anatomy. Bothwere to achieve phenomenal success--the one in a few years torevolutionize anatomy, the other within twenty years to be thecontroller of universities, the counsellor of kings, and thefounder of the most famous order in the Roman Catholic Church.It was in this hospital that Vesalius made observations on theChina-root, on which he published a monograph in 1546. The PaduanSchool was close to Venice and associated with it, so that theyoung student had probably many opportunities of going to andfro. On the sixth of December, 1537, before he had reached histwenty-fourth year and shortly after taking his degree, he waselected to the chair of surgery and anatomy at Padua.

The task Vesalius set himself to accomplish was to give anaccurate description of all the parts of the human body, withproper illustrations. He must have had abundant material, more,probably, than any teacher before him had ever had at hisdisposal. We do not know where he conducted his dissections, asthe old amphitheatre has disappeared, but it must have been verydifferent from the tiny one put up by his successor, Fabricius,in 1594. Possibly it was only a temporary building, for he saysin the second edition of the "Fabrica" that he had a splendidlecture theatre which accommodated more than five hundredspectators (p. 681).

With Vesalius disappeared the old didactic method of teachinganatomy. He did his own dissections, made his own preparations,and, when human subjects were scarce, employed dogs, pigs orcats, and occasionally a monkey. For five years he taught andworked at Padua. He is known to have given public demonstrationsin Bologna and elsewhere. In the "China-root" he remarks that heonce taught in three universities in one year. The first fruit ofhis work is of great importance in connection with the evolutionof his knowledge. In 1538, he published six anatomical tablesissued apparently in single leaves. Of the famous "TabulaeAnatomicae" only two copies are known, one in the San MarcoLibrary, Venice, and the other in the possession of Sir JohnStirling-Maxwell, whose father had it reproduced in facsimile

(thirty copies only) in 1874. Some of the figures were drawn byVesalius himself, and some are from the pencil of his friend andcountryman, Stephan van Calcar. Those plates were extensivelypirated. About this time he also edited for the Giunti some ofthe anatomical works of Galen.[21]

[21 De anatomicis administrationibus, De venarum arterinrumquedissectione, included in the various Juntine editions of Galen.

We know very little of his private life at Padua. His mostimportant colleague in the faculty was the famous Montanus,professor of medicine. Among his students and associates was theEnglishman Caius, who lived in the same house with him. When theoutput is considered, he cannot have had much spare time atPadua.

He did not create human anatomy--that had been done by theAlexandrians--but he studied it in so orderly and thorough amanner that for the first time in history it could be presentedin a way that explained the entire structure of the human body.Early in 1542 the MS. was ready; the drawings had been made withinfinite care, the blocks for the figures had been cut, and inSeptember, he wrote to Oporinus urging that the greatest painsshould be taken with the book, that the paper should be strongand of equal thickness, the workmen chosen for their skill, andthat every detail of the pictures must be distinctly visible. Hewrites with the confidence of a man who realized the significanceof the work he had done. It is difficult to speak in terms ofmoderation of the "Fabrica." To appreciate its relative valueone must compare it with the other anatomical works of theperiod, and for this purpose I put before you two figures from atext-book on the subject that was available for students duringthe first half of the sixteenth century. In the figures and textof the "Fabrica" we have anatomy as we know it; and let us behonest and say, too, largely as Galen knew it. Time will notallow me to go into the question of the relations of these twogreat anatomists, but we must remember that at this period Galenruled supreme, and was regarded in the schools as infallible.And now, after five years of incessant labor, Vesalius wasprepared to leave his much loved Padua and his devoted students.He had accomplished an extraordinary work. He knew, I feel sure,what he had done. He knew that the MSS. contained something thatthe world had not seen since the great Pergamenian sent the rollsof his "Manual of Anatomy" among his friends. Too precious toentrust to any printer but the best--and the best in the middleof the sixteenth century was Transalpine--he was preparing to gonorth with the precious burden. We can picture the youthfulteacher--he was but twenty-eight--among students in a universitywhich they themselves controlled--some of them perhaps the verymen who five years before had elected him--at the last meetingwith his class, perhaps giving a final demonstration of thewoodcuts, which were of an accuracy and beauty never seen beforeby students' eyes, and reading his introduction. There would besad hearts at the parting, for never had anyone taught anatomy ashe had taught it--no one had ever known anatomy as he knew it.But the strong, confident look was on his face and with the

courage of youth and sure of the future, he would picture a happyreturn to attack new and untried problems. Little did he dreamthat his happy days as student and teacher were finished, thathis work as an anatomist was over, that the most brilliant andepoch-making part of his career as a professor was a thing of thepast. A year or more was spent at Basel with his friend Oporinussupervising the printing of the great work, which appeared in1543 with the title "De Humani Corporis Fabrica." The worth of abook, as of a man, must be judged by results, and, so judged, the"Fabrica" is one of the great books of the world, and would comein any century of volumes which embraced the richest harvest ofthe human mind. In medicine, it represents the full flower of theRenaissance. As a book it is a sumptuous tome a worthy settingof his jewel--paper, type and illustration to match, as you maysee for yourselves in this folio--the chef d'oeuvre of anymedical library.

In every section, Vesalius enlarged and corrected the work ofGalen. Into the details we need not enter: they are all givenin Roth's monograph, and it is a chapter of ancient history notspecially illuminating.

Never did a great piece of literary work have a better setting.Vesalius must have had a keen appreciation of the artistic sideof the art of printing, and he must also have realized the factthat the masters of the art had by this time moved north of theAlps.

While superintending the printing of the precious work in thewinter of 1542-1543 in Basel, Vesalius prepared for the medicalschool a skeleton from the body of an executed man, which isprobably the earliest preparation of the kind in Europe. Howlittle anatomy had been studied at the period may be judged fromthat fact that there had been no dissection at Basel since1531.[22] The specimen is now in the Vesalianum, Basel, of whichI show you a picture taken by Dr. Harvey Cushing. From thetypographical standpoint no more superb volume on anatomy hasbeen issued from any press, except indeed the second edition,issued in 1555. The paper is, as Vesalius directed, strong andgood, but it is not, as he asked, always of equal thickness; as arule it is thick and heavy, but there are copies on a good paperof a much lighter quality. The illustrations drawn by his friendand fellow countryman, van Calcar, are very much in advance ofanything previously seen, except those of Leonardo. Thetitle-page, one of the most celebrated pictures in the history ofmedicine, shows Vesalius in a large amphitheatre (an imaginaryone of the artist, I am afraid) dissecting a female subject. Heis demonstrating the abdomen to a group of students about thetable, but standing in the auditorium are elderly citizens andeven women. One student is reading from an open book. There is amonkey on one side of the picture and a dog on the other. Abovethe picture on a shield are the three weasels, the arms of Vesal.The reproduction which I show you here is from the "Epitome"--asmaller work issued before [?] the "Fabrica," with rather largerplates, two of which represent nude human bodies and are notreproduced in the great work. The freshest and most beautifulcopy is the one on vellum which formerly belonged to Dr. Mead,

now in the British Museum, and from it this picture was taken.One of the most interesting features of the book are thefull-page illustrations of the anatomy of the arteries, veins andnerves. They had not in those days the art of making corrosionpreparations, but they could in some way dissect to their finestramifications the arteries, veins and nerves, which were thenspread on boards and dried. Several such preparations are now atthe College of Physicians in London, brought from Padua byHarvey. The plates of the muscles are remarkably good, morecorrect, though not better perhaps, on the whole, than some ofLeonardo's.

[22] The next, in 1559, is recorded by Plater in hisautobiography, who gave a public dissection during three days inthe Church of St. Elizabeth.

Vesalius had no idea of a general circulation. Though he hadescaped from the domination of the great Pergamenian in anatomy,he was still his follower in physiology. The two figuresannexed, taken from one of the two existing copies of the"Tabulae Anatomica," are unique in anatomical illustration, andare of special value as illustrating the notion of the vascularsystem that prevailed until Harvey's day. I have already calledyour attention to Galen's view of the two separate systems, onecontaining the coarse, venous blood for the general nutrition ofthe body, the other the arterial, full of a thinner, warmer bloodwith which were distributed the vital spirits and the vital heat.The veins had their origin in the liver; the superior vena cavacommunicated with the right heart, and, as Galen taught, someblood was distributed to the lungs; but the two systems wereclosed, though Galen believed there was a communication at theperiphery between the arteries and veins. Vesalius acceptedGalen's view that there is some communication between the venousand arterial systems through pores in the septum of theventricles, though he had his doubts, and in the second editionof his book (1555) says that inspite of the authority of thePrince of Physicians he cannot see how the smallest quantity ofblood could be transmitted through so dense a muscular septum.Two years before this (1553),[*] his old fellow student, MichaelServetus, had in his "Christianismi Restitutio" annatomical touchwith one another!

[*] See the Servetus Notes in the Osler Anniversary Volumes, NewYork, 1919, Vol. II.--Ed.

The publication of the "Fabrica" shook the medical world to itsfoundations. Galen ruled supreme in the schools: to doubt him inthe least particular roused the same kind of feeling as diddoubts on the verbal inspiration of the Scriptures fifty yearsago! His old teachers in Paris were up in arms: Sylvius, nostraeaetatis medicorum decus, as Vesalius calls him, wrote furiousletters, and later spoke of him as a madman (vaesanus). Theyounger men were with him and he had many friends, but he hadaroused a roaring tide of detraction against which he protested a

few years later in his work on the "China-root," which is full ofdetails about the "Fabrica." In a fit of temper he threw hisnotes on Galen and other MSS. in the fire. No sadder page existsin medical writings than the one in which Vesalius tells of theburning of his books and MSS. It is here reproduced andtranslated.[23] His life for a couple of years is not easy tofollow, but we know that in 1546 he took service with Charles Vas his body physician, and the greatest anatomist of his age waslost in the wanderings of court and campaigns. He became anactive practitioner, a distinguished surgeon, much consulted byhis colleagues, and there are references to many of his cases,the most important of which are to internal aneurysms, which hewas one of the first to recognize. In 1555 he brought out thesecond edition of the "Fabrica," an even more sumptuous volumethan the first.

[23] Epistle on China-root, 1546, p. 196. Vesalius may be quotedin explanation--in palliation:

"All these impediments I made light of; for I was too young toseek gain by my art, and I was sustained by my eager desire tolearn and to promote the studies in which I shared. I saynothing of my diligence in anatomizing--those who attended mylectures in Italy know how I spent three whole weeks over asingle public dissection. But consider that in one year I oncetaught in three different universities. If I had put off the taskof writing till this time; if I were now just beginning to digestmy materials; students would not have had the use of myanatomical labours, which posterity may or may not judge superiorto the rechauffes formerly in use, whether of Mesua, ofGatinaria, of some Stephanus or other on the differences, causesand symptoms of diseases, or, lastly, of a part of Servitor'spharmacopoeia. As to my notes, which had grown into a hugevolume, they were all destroyed by me; and on the same day theresimilarly perished the whole of my paraphrase on the ten books ofRhazes to King Almansor, which had been composed by me with farmore care than the one which is prefaced to the ninth book. Withthese also went the books of some author or other on the formulaeand preparation of medicines, to which I had added much matter ofmy own which I judged to be not without utility; and the samefate overtook all the books of Galen which I had used in learninganatomy, and which I had liberally disfigured in the usualfashion. I was on the point of leaving Italy and going to Court;those physicians you know of had made to the Emperor and to thenobles a most unfavourable report of my books and of all that ispublished nowadays for the promotion of study; I therefore burntall these works that I have mentioned, thinking at the same timethat it would be an easy matter to abstain from writing for thefuture. I must show that I have since repented more than once ofmy impatience, and regretted that I did not take the advice ofthe friends who were then with me."

There is no such pathetic tragedy in the history of ourprofession. Before the age of thirty Vesalius had effected arevolution in anatomy; he became the valued physician of thegreatest court of Europe; but call no man happy till he is dead!

A mystery surrounds his last days. The story is that he hadobtained permission to perform a post-mortem examination on thebody of a young Spanish nobleman, whom he had attended. When thebody was opened, the spectators to their horror saw the heartbeating, and there were signs of life! Accused, so it is said,by the Inquisition of murder and also of general impiety he onlyescaped through the intervention of the King, with the conditionthat he make a pilgrimage to the Holy Land. In carrying this outin 1564 he was wrecked on the island of Zante, where he died of afever or of exhaustion, in the fiftieth year of his age.

To the North American Review, November, 1902, Edith Whartoncontributed a poem on "Vesalius in Zante," in which she pictureshis life, so full of accomplishment, so full of regrets--regretsaccentuated by the receipt of an anatomical treatise byFallopius, the successor to the chair in Padua! She makes himsay:

There are two ways of spreading light; to beThe candle or the mirror that reflects it.I let my wick burn out--there yet remainsTo spread an answering surface to the flameThat others kindle.

But between Mundinus and Vesalius, anatomy had been studied by agroup of men to whom I must, in passing, pay a tribute. The greatartists Raphael, Michael Angelo and Albrecht Durer were keenstudents of the human form. There is an anatomical sketch byMichael Angelo in the Ashmolean Museum, Oxford, which I herereproduce.[*] Durer's famous work on "Human Proportion,"published in 1528, contains excellent figures, but no sketches ofdissections. But greater than any of these, and antedating them,is Leonardo da Vinci, the one universal genius in whom the newspirit was incarnate--the Moses who alone among hiscontemporaries saw the promised land. How far Leonardo wasindebted to his friend and fellow student, della Torre, at Paviawe do not know, nor does it matter in face of the indubitablefact that in the many anatomical sketches from his hand we havethe first accurate representation of the structure of the body.Glance at the three figures of the spine which I have hadphotographed side by side, one from Leonardo, one from Vesaliusand the other from Vandyke Carter, who did the drawings in Gray's"Anatomy" (1st ed., 1856). They are all of the same type,scientific, anatomical drawings, and that of Leonardo was donefifty years before Vesalius! Compare, too, this figure of thebones of the foot with a similar one from Vesalius.[24] Insatiatein experiment, intellectually as greedy as Aristotle, painter,poet, sculptor, engineer, architect, mathematician, chemist,botanist, aeronaut, musician and withal a dreamer and mystic,full accomplishment in any one department was not for him! Apassionate desire for a mastery of nature's secrets made him afierce thing, replete with too much rage! But for us a recordremains-- Leonardo was the first of modern anatomists, and fiftyyears later, into the breach he made, Vesalius entered.[25]

[*] This plate was lacking among the author's illustrations, but

the Keeper of the Ashmolean Museum remembers his repeatedlyshowing special interest in the sketch reproduced in JohnAddington Symonds's Life of Michelangelo, London, 1893, Vol. I,p. 44, and in Charles Singer's Studies in the History and Methodof Science, Oxford, 1917, Vol. I, p. 97, representing MichaelAngelo and a friend dissecting the body of a man, by the light ofa candle fixed in the body itself.--Ed.

[24] He was the first to make and represent anatomical crosssections. See Leonardo: Quaderni d'Anatomia, Jacob Dybwad,Kristiania, 1911-1916, Vol. V.

[25] See Knox: Great Artists and Great Anatomists, London, 1862,and Mathias Duval in Les Manuserits de Leonard de Vince: Del'Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898. For agood account of Leonardo da Vinci see Merejkovsky's novel, TheForerunner, London, 1902, also New York, Putnam.

HARVEY

LET us return to Padua about the year 1600. Vesalius, who madethe school the most famous anatomical centre in Europe, wassucceeded by Fallopius, one of the best-known names in anatomy,at whose death an unsuccessful attempt was made to get Vesaliusback. He was succeeded in 1565 by a remarkable man, Fabricius(who usually bears the added name of Aquapendente, from the townof his birth), a worthy follower of Vesalius. In 1594, in thethirtieth year of his professoriate, he built at his own expensea new anatomical amphitheatre, which still exists in theuniversity buildings. It is a small, high-pitched room with sixstanding-rows for auditors rising abruptly one above the other.The arena is not much more than large enough for the dissectingtable which, by a lift, could be brought up from a preparing roombelow. The study of anatomy at Padua must have declined since thedays of Vesalius if this tiny amphitheatre held all its students;none the less, it is probably the oldest existing anatomicallecture room, and for us it has a very special significance.

Early in his anatomical studies Fabricius had demonstrated thevalves in the veins. I show you here two figures, the first, asfar as I know, in which these structures are depicted. It doesnot concern us who first discovered them; they had doubtless beenseen before, but Fabricius first recognized them as generalstructures in the venous system, and he called them littledoors--"ostiola."

The quadrangle of the university building at Padua is surroundedby beautiful arcades, the walls and ceilings of which areeverywhere covered with the stemmata, or shields, of formerstudents, many of them brilliantly painted. Standing in thearcade on the side of the "quad" opposite the entrance, if onelooks on the ceiling immediately above the capital of the secondcolumn to the left there is seen the stemma which appears astailpiece to this chapter, put up by a young Englishman, WilliamHarvey, who had been a student at Padua for four years. Hebelonged to the "Natio Anglica," of which he was Conciliarius,

and took his degree in 1602. Doubtless he had repeatedly seenFabricius demonstrate the valves of the veins, and he may indeed,as a senior student, have helped in making the very dissectionsfrom which the drawings were taken for Fabricius' work, "DeVenarum Osteolis," 1603. If one may judge from the character ofthe teacher's work the sort of instruction the student receives,Harvey must have had splendid training in anatomy. While he wasat Padua, the great work of Fabricius, "De Visione, Voce etAuditu" (1600) was published, then the "Tractatus de OculoVisusque Organo" (1601), and in the last year of his residenceFabricius must have been busy with his studies on the valves ofthe veins and with his embryology, which appeared in 1604. Latein life, Harvey told Boyle that it was the position of the valvesof the veins that induced him to think of a circulation.

Harvey returned to England trained by the best anatomist of hisday. In London, he became attached to the College of Physicans,and taking his degree at Cambridge, he began the practice ofmedicine. He was elected a fellow of the college in 1607 andphysician to St. Bartholomew's Hospital in 1609. In 1615 he wasappointed Lumleian lecturer to the College of Physicians, and hisduties were to hold certain "public anatomies," as they werecalled, or lectures. We know little or nothing of what Harveyhad been doing other than his routine work in the care of thepatients at St. Bartholomew's. It was not until April, 1616, thathis lectures began. Chance has preserved to us the notes of thisfirst course; the MS. is now in the British Museum and waspublished in facsimile by the college in 1886.[26]

[26] William Harvey: Prelectiones Anatomiae Universalis, London,J. & A. Churchill, 1886.

The second day lecture, April 17, was concerned with adescription of the organs of the thorax, and after a discussionon the structure and action of the heart come the lines:

W. H. constat per fabricam cordis sanguinem per pulmones in Aortam perpetuo transferri, as by two clacks of a water bellows to rayse water constat per ligaturam transitum sanguinis ab arteriis ad venas unde perpetuum sanguinis motum in circulo fieri pulsu cordis.

The illustration will give one an idea of the extraordinarilycrabbed hand in which the notes are written, but it is worthwhile to see the original, for here is the first occasion uponwhich is laid down in clear and unequivocal words that the bloodCIRCULATES. The lecture gave evidence of a skilled anatomist,well versed in the literature from Aristotle to Fabricius. Inthe MS. of the thorax, or, as he calls it, the "parlour" lecture,there are about a hundred references to some twenty authors. Theremarkable thing is that although those lectures were repeatedyear by year, we have no evidence that they made any impressionupon Harvey's contemporaries, so far, at least, as to excite

discussions that led to publication. It was not until twelveyears later, 1628, that Harvey published in Frankfurt a smallquarto volume of seventy-four pages,[27] "De Motu Cordis." Incomparison with the sumptuous "Fabrica" of Vesalius this is atrifling booklet; but if not its equal in bulk or typographicalbeauty (it is in fact very poorly printed), it is its counterpartin physiology, and did for that science what Vesalius had donefor anatomy, though not in the same way. The experimental spiritwas abroad in the land, and as a student at Padua, Harvey musthave had many opportunities of learning the technique ofvivisection; but no one before his day had attempted an elaboratepiece of experimental work deliberately planned to solve aproblem relating to the most important single function of thebody. Herein lies the special merit of his work, from every pageof which there breathes the modern spirit. To him, as toVesalius before him, the current views of the movements of theblood were unsatisfactory, more particularly the movements of theheart and arteries, which were regarded as an active expansion bywhich they were filled with blood, like bellows with air. Thequestion of the transmission of blood through the thick septumand the transference of air and blood from the lungs to the heartwere secrets which he was desirous of searching out by means ofexperiment.

[27] Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinisin Animalibus, Francofurti, 1628.

One or two special points in the work may be referred to asillustrating his method. He undertook first the movements of theheart, a task so truly arduous and so full of difficulties thathe was almost tempted to think with Fracastorius that "themovement of the heart was only to be comprehended by God." Butafter many difficulties he made the following statements: first,that the heart is erected and raises itself up into an apex, andat this time strikes against the breast and the pulse is feltexternally; secondly, that it is contracted every-way, but moreso at the sides; and thirdly, that grasped in the hand it wasfelt to become harder at the time of its motion; from all ofwhich actions Harvey drew the very natural conclusion that theactivity of the heart consisted in a contraction of its fibres bywhich it expelled the blood from the ventricles. These were thefirst four fundamental facts which really opened the way for thediscovery of the circulation, as it did away with the belief thatthe heart in its motion attracts blood into the ventricles,stating on the contrary that by its contraction it expelled theblood and only received it during its period of repose orrelaxation. Then he proceeded to study the action of the arteriesand showed that their period of diastole, or expansion,corresponded with the systole, or contraction, of the heart, andthat the arterial pulse follows the force, frequency and rhythmof the ventricle and is, in fact, dependent upon it. Here wasanother new fact: that the pulsation in the arteries was nothingelse than the impulse of the blood within them. Chapter IV, inwhich he describes the movements of the auricles and ventricles,is a model of accurate description, to which little has sincebeen added. It is interesting to note that he mentions what is

probably auricular fibrillation. He says: "After the heart hadceased pulsating an undulation or palpitation remained in theblood itself which was contained in the right auricle, this beingobserved so long as it was imbued with heat and spirit." Herecognized too the importance of the auricles as the first tomove and the last to die. The accuracy and vividness of Harvey'sdescription of the motion of the heart have been appreciated bygenerations of physiologists. Having grasped this firstessential fact, that the heart was an organ for the propulsion ofblood, he takes up in Chapters VI and VII the question of theconveyance of the blood from the right side of the heart to theleft. Galen had already insisted that some blood passed from theright ventricle to the lungs--enough for their nutrition; butHarvey points out, with Colombo, that from the arrangement of thevalves there could be no other view than that with each impulseof the heart blood passes from the right ventricle to the lungsand so to the left side of the heart. How it passed through thelungs was a problem: probably by a continuous transudation. InChapters VIII and IX he deals with the amount of blood passingthrough the heart from the veins to the arteries. Let me quotehere what he says, as it is of cardinal import:

"But what remains to be said upon the quantity and source of theblood which thus passes, is of a character so novel and unheardof that I not only fear injury to myself from the envy of a few,but I tremble lest I have mankind at large for my enemies, somuch doth wont and custom become a second nature. Doctrine oncesown strikes deeply its root, and respect for antiquityinfluences all men. Still the die is cast, and my trust is in mylove of truth, and the candour of cultivated minds."[28] Then hegoes on to say:

[28] William Harvey: Exercitatio Anatomica de Motu Cordis etSanguinis in Animalibus, Francofurti, 1628, G. Moreton'sfacsimile reprint and translation, Canterbury, 1894, p. 48.

I began to think whether there might not be A MOVEMENT, AS ITWERE, IN A CIRCLE. Now this I afterwards found to be true; and Ifinally saw that the blood, forced by the action of the leftventricle into the arteries, was distributed to the body atlarge, and its several parts, in the same manner as it is sentthrough the lungs, impelled by the right ventricle into thepulmonary artery, and that it then passed through the veins andalong the vena cava, and so round to the left ventricle in themanner already indicated."[29]

[29] Ibid. p. 49.

The experiments dealing with the transmission of blood in theveins are very accurate, and he uses the old experiment thatFabricius had employed to show the valves, to demonstrate thatthe blood in the veins flows towards the heart. For the firsttime a proper explanation of the action of the valves is given.Harvey had no appreciation of how the arteries and veinscommunicated with each other. Galen, you may remember,

recognized that there were anastomoses, but Harvey preferred theidea of filtration.

The "De Motu Cordis" constitutes a unique piece of work in thehistory of medicine. Nothing of the same type had appearedbefore. It is a thoroughly sensible, scientific study of adefinite problem, the solution of which was arrived at throughthe combination of accurate observation and ingenious experiment.Much misunderstanding has arisen in connection with Harvey'sdiscovery of the circulation of the blood. He did not discoverthat the blood moved,--that was known to Aristotle and to Galen,from both of whom I have given quotations which indicate clearlythat they knew of its movement,--but at the time of Harvey not asingle anatomist had escaped from the domination of Galen'sviews. Both Servetus and Colombo knew of the pulmonarycirculation, which was described by the former in very accurateterms. Cesalpinus, a great name in anatomy and botany, for whomis claimed the discovery of the circulation, only expressed theaccepted doctrines in the following oft-quoted phrase:

"We will now consider how the attraction of aliment and theprocess of nutrition takes place in plants; for in animals we seethe aliment brought through the veins to the heart, as to alaboratory of innate heat, and, after receiving there its finalperfection, distributed through the arteries to the body atlarge, by the agency of the spirits produced from this samealiment in the heart."[30] There is nothing in this but Galen'sview, and Cesalpinus believed, as did all his contemporaries,that the blood was distributed through the body by the vena cavaand its branches for the nourishment of all its parts.[*] Tothose who have any doubts as to Harvey's position in this matterI would recommend the reading of the "De Motu Cordis" itself,then the various passages relating to the circulation fromAristotle to Vesalius. Many of these can be found in theadmirable works of Dalton, Flourens, Richet and Curtis.[31] In myHarveian Oration for 1906[32] I have dealt specially with thereception of the new views, and have shown how long it was beforethe reverence for Galen allowed of their acceptance. TheUniversity of Paris opposed the circulation of the blood for morethan half a century after the appearance of the "De Motu Cordis."

[30] De Plantis, Lib I, cap. 2.

[*] Cesalpinus has also a definite statement of the circlewiseprocess.--Ed.

[31] J. C. Dalton Doctrines of the Circulation, Philadelphia,1884; Flourens Histoire de la decouverte de la circulation dusang, 2d ed., Paris, 1857; Charles Richet Harvey, la circulationdu sang, Paris, 1879; John G. Curtis Harvey's views on the use ofCirculation, etc., New York, 1916.

[32] Osler An Alabama Student and Other Biographical Essays,Oxford, 1908, p. 295.

To summarize--until the seventeenth century there were believed

to be two closed systems in the circulation, (1) the natural,containing venous blood, had its origin in the liver from which,as from a fountain, the blood continually ebbed and flowed forthe nourishment of the body; (2) the vital, containing anotherblood and the spirits, ebbed and flowed from the heart,distributing heat and life to all parts. Like a bellows the lungsfanned and cooled this vital blood. Here and there we findglimmering conceptions of a communication between these systems,but practically all teachers believed that the only one ofimportance was through small pores in the wall separating the twosides of the heart. Observation--merely looking at and thinkingabout things--had done all that was possible, and furtherprogress had to await the introduction of a new method, viz.,experiment. Galen, it is true, had used this means to show thatthe arteries of the body contained blood and not air. The day hadcome when men were no longer content with accurate descriptionand with finely spun theories and dreams. It was reserved for theimmortal Harvey to put into practice the experimental method bywhich he demonstrated conclusively that the blood moved in acircle. The "De Motu Cordis" marks the final break of the modernspirit with the old traditions. It took long for men to realizethe value of this "inventum mirabile" used so effectively by theAlexandrians--by Galen--indeed, its full value has only beenappreciated within the past century. Let me quote a paragraphfrom my Harveian Oration.[33] "To the age of the hearer, in whichmen had heard and heard only, had succeeded the age of the eye inwhich men had seen and had been content only to see. But at lastcame the age of the hand-- the thinking, devising, planning hand,the hand as an instrument of the mind, now re-introduced into theworld in a modest little monograph from which we may date thebeginning of experimental medicine."

[33] Osler: An Alabama Student, etc., pp. 329-330.

Harvey caught the experimental spirit in Italy, with brain, eyeand hand as his only aids, but now an era opened in whichmedicine was to derive an enormous impetus from the discovery ofinstruments of precision. "The new period in the development ofthe natural sciences, which reached its height in the work ofsuch men as Galileo, Gilbert and Kepler, is chiefly characterizedby the invention of very important instruments for aiding andintensifying the perceptions of the senses, by means of which wasgained a much deeper insight into the phenomena than had hithertobeen possible. Such instruments as the earlier ages possessedwere little more than primitive hand-made tools. Now we find aconsiderable number of scientifically made instrumentsdeliberately planned for purposes of special research, and as itwere, on the threshold of the period stand two of the mostimportant, the compound microscope and the telescope. The formerwas invented about 1590 and the latter about 1608."[34] It was afellow professor of the great genius Galileo who attempted to putinto practice the experimental science of his friend. WithSanctorius began the studies of temperature, respiration and thephysics of the circulation. The memory of this great investigatorhas not been helped by the English edition of his "De StaticaMedicina," not his best work, with a frontispiece showing the

author in his dietetic balance. Full justice has been done to himby Dr. Weir Mitchell in an address as president of the Congressof Physicians and Surgeons, 1891.[35] Sanctorius worked with apulsilogue devised for him by Galileo, with which he madeobservations on the pulse. He is said to have been the first toput in use the clinical thermometer. His experiments oninsensible perspiration mark him as one of the first modernphysiologists.

[34] Dannemann: Die Naturwissenschaften in ihrerEntwickelung..., Vol. II, p. 7, Leipzig, 1911.

[35] See Transactions Congress Physicians and Surgeons, 1891, NewHaven, 1892, II, 159-181.

But neither Sanctorius nor Harvey had the immediate influenceupon their contemporaries which the novel and stimulatingcharacter of their work justified. Harvey's great contemporary,Bacon, although he lost his life in making a cold storageexperiment, did not really appreciate the enormous importance ofexperimental science. He looked very coldly upon Harvey's work.It was a philosopher of another kidney, Rene Descartes, who didmore than anyone else to help men to realize the value of thebetter way which Harvey had pointed out. That the beginning ofwisdom was in doubt, not in authority, was a novel doctrine inthe world, but Descartes was no armchair philosopher, and hisstrong advocacy and practice of experimentation had a profoundinfluence in directing men to "la nouvelle methode." He broughtthe human body, the earthly machine, as he calls it, into thesphere of mechanics and physics, and he wrote the first text-bookof physiology, "De l'Homme." Locke, too, became the spokesman ofthe new questioning spirit, and before the close of theseventeenth century, experimental research became all the mode.Richard Lower, Hooke and Hales were probably more influenced byDescartes than by Harvey, and they made notable contributions toexperimental physiology in England. Borelli, author of thefamous work on "The Motion of Animals" (Rome, 1680-1681), broughtto the study of the action of muscles a profound knowledge ofphysics and mathematics and really founded the mechanical, oriatromechanical school. The literature and the language ofmedicine became that of physics and mechanics: wheels andpulleys, wedges, levers, screws, cords, canals. cisterns, sievesand strainers, with angles, cylinders, celerity, percussion andresistance, were among the words that now came into use inmedical literature. Withington quotes a good example in adescription by Pitcairne, the Scot who was professor of medicineat Leyden at the end of the seventeenth century. "Life is thecirculation of the blood. Health is its free and painlesscirculation. Disease is an abnormal motion of the blood, eithergeneral or local. Like the English school generally, he is farmore exclusively mechanical than are the Italians, and will hearnothing of ferments or acids, even in digestion. This, hedeclares, is a purely mechanical process due to heat andpressure, the wonderful effects of which may be seen in Papin'srecently invented 'digester.' That the stomach is fully able tocomminute the food may be proved by the following calculation.

Borelli estimates the power of the flexors of the thumb at 3720pounds, their average weight being 122 grains. Now, the averageweight of the stomach is eight ounces, therefore it can develop aforce of 117,088 pounds, and this may be further assisted by thediaphragm and abdominal muscles the power of which, estimated inthe same way, equals 461,219 pounds! Well may Pitcairne add thatthis force is not inferior to that of any millstone."[36]Paracelsus gave an extraordinary stimulus to the study ofchemistry and more than anyone else he put the old alchemy onmodern lines. I have already quoted his sane remark that itschief service is in seeking remedies. But there is another sideto this question. If, as seems fairly certain, the BasilValentine whose writings were supposed to have inspiredParacelsus was a hoax and his works were made up in great partfrom the writings of Paracelsus, then to our medical Luther, andnot to the mythical Benedictine monk, must be attributed a greatrevival in the search for the Philosopher's Stone, for the Elixirof Life, for a universal medicine, for the perpetuum mobile andfor an aurum potabile.[37] I reproduce, almost at random, a pagefrom the fifth and last part of the last will and testament ofBasil Valentine (London, 1657), from which you may judge thechemical spirit of the time.

[36] Withington: Medical History from the Earliest Times,London, 1891, Scientific Press, p. 317.

[37] See Professor Stillman on the Basil Valentine hoax, PopularScience Monthly, New York, 1919, LXXXI, 591-600.

Out of the mystic doctrines of Paracelsus arose the famous"Brothers of the Rosy Cross." "The brotherhood was possessed ofthe deepest knowledge and science, the transmutation of metals,the perpetuum mobile and the universal medicine were among theirsecrets; they were free from sickness and suffering during theirlifetime, though subject finally to death."[38]

[38] Ferguson: Bibliotheca Chemica, Vol. II, p. 290. For anaccount of Fludd and the English Rosicrucians see Craven's Lifeof Fludd, Kirkwall, 1902.

A school of a more rational kind followed directly upon the workof Paracelsus, in which the first man of any importance was VanHelmont. The Paracelsian Archeus was the presiding spirit inliving creatures, and worked through special local ferments, bywhich the functions of the organs are controlled. Disease of anypart represents a strike on the part of the local Archeus, whorefuses to work. Though full of fanciful ideas, Van Helmont hadthe experimental spirit and was the first chemist to discover thediversity of gases. Like his teacher, he was in revolt againstthe faculty, and he has bitter things to say of physicians. Hegot into trouble with the Church about the magnetic cure ofwounds, as no fewer than twenty-seven propositions incompatiblewith the Catholic faith were found in his pamphlet (Ferguson).The Philosophus per ignem, Toparcha in Merode, Royenborch, as heis styled in certain of his writings, is not an easy man to

tackle. I show the title-page of the "Ortus Medicinae," thecollection of his works by his son. As with the pages ofParacelsus, there are many gems to be dug out. The counterblastagainst bleeding was a useful protest, and to deny in toto itsutility in fever required courage-- a quality never lacking inthe Father of Modern Chemistry, as he has been called.

A man of a very different type, a learned academic, a professorof European renown, was Daniel Sennert of Wittenberg, the firstto introduce the systematic teaching of chemistry into thecurriculum, and who tried to harmonize the Galenists andParacelsians. Franciscus Sylvius, a disciple of Van Helmont,established the first chemical laboratory in Europe at Leyden,and to him is due the introduction of modern clinical teaching.In 1664 he writes: "I have led my pupils by the hand to medicalpractice, using a method unknown at Leyden, or perhaps elsewhere,i.e., taking them daily to visit the sick at the public hospital.There I have put the symptoms of disease before their eyes; havelet them hear the complaints of the patients, and have asked themtheir opinions as to the causes and rational treatment of eachcase, and the reasons for those opinions. Then I have given myown judgment on every point. Together with me they have seen thehappy results of treatment when God has granted to our cares arestoration of health; or they have assisted in examining thebody when the patient has paid the inevitable tribute todeath."[39]

[39] Withington: Medical History from the Earliest Times,London, 1894, pp. 312-313.

Glauber, Willis, Mayow, Lemery, Agricola and Stahl led up toRobert Boyle, with whom modern chemistry may be said to begin.Even as late as 1716, Lady Mary Wortley Montagu in Vienna foundthat all had transferred their superstitions from religion tochemistry; "scarcely a man of opulence or fashion that has not analchemist in his service." To one scientific man of the period Imust refer as the author of the first scientific book publishedin England. Dryden sings:

Gilbert shall live till load-stones cease to draw Or British fleets the boundless ocean awe.

And the verse is true, for by the publication in 1600 of the "DeMagnete" the science of electricity was founded. William Gilbertwas a fine type of the sixteenth-century physician, a Colchesterman, educated at St. John's College, Cambridge. SilvanusThompson says: "He is beyond question rightfully regarded as theFather of Electric Science. He founded the entire subject ofTerrestrial Magnetism. He also made notable contributions toAstronomy, being the earliest English expounder of Copernicus.In an age given over to metaphysical obscurities and dogmaticsophistry, he cultivated the method of experiment and ofreasoning from observation, with an insight and success whichentitles him to be regarded as the father of the inductivemethod. That method, so often accredited to Bacon, Gilbert waspracticing years before him."[40]

[40] Silvanus P. Thompson: Gilbert of Colchester, Father ofElectrical Science, London, Chiswick Press, 1903, p. 3.

CHAPTER V

THE RISE AND DEVELOPMENT OF MODERN MEDICINE

THE middle of the seventeenth century saw the profession thus faron its way--certain objective features of disease were known, theart of careful observation had been cultivated, many empiricalremedies had been discovered, the coarser structure of man's bodyhad been well worked out, and a good beginning had been made inthe knowledge of how the machinery worked--nothing more. Whatdisease really was, where it was, how it was caused, had not evenbegun to be discussed intelligently.

An empirical discovery of the first importance marks the middleof the century. The story of cinchona is of special interest, asit was the first great specific in disease to be discovered. In1638, the wife of the Viceroy of Peru, the Countess of Chinchon,lay sick of an intermittent fever in the Palace of Lima. Afriend of her husband's, who had become acquainted with thevirtues, in fever, of the bark of a certain tree, sent a parcelof it to the Viceroy, and the remedy administered by herphysician, Don Juan del Vego, rapidly effected a cure. In 1640,the Countess returned to Spain, bringing with her a supply ofquina bark, which thus became known in Europe as "the Countess'sPowder" (pulvis Comitissae). A little later, her doctor followed,bringing additional quantities. Later in the century, the JesuitFathers sent parcels of the bark to Rome, whence it wasdistributed to the priests of the community and used for the cureof ague; hence the name of "Jesuits' bark." Its value was earlyrecognized by Sydenham and by Locke. At first there was a greatdeal of opposition, and the Protestants did not like it becauseof its introduction by the Jesuits. The famous quack, RobertTalbor, sold the secret of preparing quinquina to Louis XIV in1679 for two thousand louis d'or, a pension and a title. That theprofession was divided in opinion on the subject was probably dueto sophistication, or to the importation of other and inertbarks. It was well into the eighteenth century before its virtueswere universally acknowledged. The tree itself was not describeduntil 1738, and Linnaeus established the genus "Chinchona" inhonor of the Countess.[1]

[1] Clements R. Markham: Peruvian Bark, John Murray, London,1880; Memoir of the Lady Anna di Osoria, Countess of Chinchonaand Vice-Queen of Peru, 1874.

A step in advance followed the objective study of the changeswrought in the body by disease. To a few of these the anatomistshad already called attention. Vesalius, always keen in hisdescription of aberrations from the normal, was one of the firstto describe internal aneurysm. The truth is, even the best of

men had little or no appreciation of the importance of the studyof these changes. Sydenham scoffs at the value of post-mortems.

Again we have to go back to Italy for the beginning of thesestudies, this time to Florence, in the glorious days of Lorenzothe Magnificent. The pioneer now is not a professor but a generalpractitioner, Antonio Benivieni, of whom we know very little savethat he was a friend of Marsilio Ficino and of Angelo Poliziano,and that he practiced in Florence during the last third of thefifteenth century, dying in 1502. Through associations with thescholars of the day. he had become a student of Greek medicineand he was not only a shrewd and accurate observer of nature buta bold and successful practitioner. He had formed the good habitof making brief notes of his more important cases, and after hisdeath these were found by his brother Jerome and published in1507.[2] This book has a rare value as the record of theexperience of an unusually intelligent practitioner of theperiod. There are in all 111 observations, most of themcommendably brief. The only one of any length deals with the new"Morbus Gallicus," of which, in the short period between itsappearance and Benivieni's death, he had seen enough to leave avery accurate description; and it is interesting to note thateven in those early days mercury was employed for its cure. Thesurgical cases are of exceptional interest, and No. 38 refers toa case of angina for which he performed a successful operation.This is supposed to have been a tracheotomy, and if so, it is thefirst in the fourteen centuries that had elapsed since the daysof Antyllus.[3] There are other important cases which show thathe was a dexterous and fearless surgeon. But the special interestof the work for us is that, for the first time in modernliterature, we have reports of post-mortem examinations madespecifically with a view to finding out the exact cause of death.Among the 111 cases, there are post-mortem records of cases ofgallstones, abscess of the mesentery, thrombosis of themesenteric veins, several cases of heart disease, senile gangreneand one of cor villosum. From no other book do we get so good anidea of a practitioner's experience at this period; the notes areplain and straightforward, and singularly free from alltheoretical and therapeutic vagaries. He gives several remarkableinstances of faith healing.

[2] De abditis nonnullis ac mirandis morborum et sanationumcausis. 8th, Florence, Gandhi, 1507.

[3] Possibly it was only a case of angina Ludovici, orretro-pharyngeal abscess.

To know accurately the anatomical changes that take place indisease is of importance both for diagnosis and for treatment.The man who created the science, who taught us to thinkanatomically of disease, was Morgagni, whose "De sedibus etcausis morborum per anatomen indagatis"[4] is one of the greatbooks in our literature. During the seventeenth century, thepractice of making post-mortem examinations had extended greatly,and in the "Sepulchretum anatomicum" of Bonetus (1679), thesescattered fragments are collected.[5] But the work of Morgagni is

of a different type, for in it are the clinical and anatomicalobservations of an able physician during a long and active life.The work had an interesting origin. A young friend interested inscience and in medicine was fond of discoursing with Morgagniabout his preceptors, particularly Valsalva and Albertini, andsometimes the young man inquired about Morgagni's ownobservations and thoughts. Yielding to a strong wish, Morgagniconsented to write his young friend familiar letters describinghis experiences. I am sorry that Morgagni does not mention thename of the man to whom we are so much indebted, and who, hestates, was so pleased with the letters that he continuallysolicited him to send more and more "till he drew me on so far asthe seventieth; . . . when I begged them of him in order torevise their contents; he did not return them, till he had mademe solemnly promise, that I would not abridge any part thereof"(Preface).

[4] Venice, 1761.

[5] Boerhaave remarked that if a man wished to deserve or get amedical degree from ONE medical author let it be this. (JamesAtkinson: Medical Bibliography, 1834, 268.)

Born in 1682, Morgagni studied at Bologna under Valsalva andAlbertini. In 1711, he was elected professor of medicine atPadua. He published numerous anatomical observations and severalsmaller works of less importance. The great work which has madehis name immortal in the profession, appeared in his eightiethyear, and represents the accumulated experience of a long life.Though written in the form of letters, the work is arrangedsystematically and has an index of exceptional value. From nosection does one get a better idea of the character and scope ofthe work than from that relating to the heart andarteries--affections of the pericardium, diseases of the valves,ulceration, rupture, dilation and hypertrophy and affections ofthe aorta are very fully described. The section on aneurysm ofthe aorta remains one of the best ever written. It is not theanatomical observations alone that make the work of unusualvalue, but the combination of clinical with anatomical records.What could be more correct than this account of anginapectoris--probably the first in the literature? "A lady forty-twoyears of age, who for a long time, had been a valetudinarian, andwithin the same period, on using pretty quick exercise of body,she was subject to attacks of violent anguish in the upper partof the chest on the left side, accompanied with a difficulty ofbreathing, and numbness of the left arm; but these paroxysms soonsubsided when she ceased from exertion. In these circumstances,but with cheerfulness of mind, she undertook a journey fromVenice, purposing to travel along the continent, when she wasseized with a paroxysm, and died on the spot. I examined the bodyon the following day.... The aorta was considerably dilated atits curvature; and, in places, through its whole tract, the innersurface was unequal and ossified. These appearances werepropagated into the arteria innominata. The aortic valves wereindurated...." He remarks, "The delay of blood in the aorta, inthe heart, in the pulmonary vessels, and in the vena cave, would

occasion the symptoms of which the woman complained during life;namely, the violent uneasiness, the difficulty of breathing, andthe numbness of the arm."[6]

[6] Cooke's Morgagni, Vol. 1, pp. 417-418. I cannot too warmlycommend to young clinicians the reading of Morgagni. Englisheditions are available--Alexander's three-volume translation of1769 and Cooke's Abridgement (London, 1822), of which there wasan American edition published in Boston in 1824.

Morgagni's life had as much influence as his work. In closecorrespondence with the leading men of the day, with the youngand rising teachers and workers, his methods must have been agreat inspiration; and he came just at the right time. Theprofession was literally ravaged by theories, schools andsystems--iatromechanics, iatrochemistry, humoralism, the animismof Stahl, the vitalistic doctrines of Van Helmont and hisfollowers-- and into this metaphysical confusion Morgagni camelike an old Greek with his clear observation, sensible thinkingand ripe scholarship. Sprengel well remarks that "it is hard tosay whether one should admire most his rare dexterity andquickness in dissection, his unimpeachable love of truth andjustice in his estimation of the work of others, his extensivescholarship and rich classical style or his downright commonsense and manly speech."

Upon this solid foundation the morbid anatomy of modern clinicalmedicine was built. Many of Morgagni's contemporaries did notfully appreciate the change that was in progress, and the valueof the new method of correlating the clinical symptoms and themorbid appearances. After all, it was only the extension of theHippocratic method of careful observation-- the study of factsfrom which reasonable conclusions could be drawn. In everygeneration there had been men of this type--I dare say many morethan we realize--men of the Benivieni character, thoroughlypractical, clear-headed physicians. A model of this sort arosein England in the middle of the seventeenth century, ThomasSydenham (1624-1689), who took men back to Hippocrates, just asHarvey had led them back to Galen. Sydenham broke with authorityand went to nature. It is extraordinary how he could have beenso emancipated from dogmas and theories of all sorts. He laiddown the fundamental proposition, and acted upon it, that "alldisease could be described as natural history." To do him justicewe must remember, as Dr. John Brown says, "in the midst of what amass of errors and prejudices, of theories actively mischievous,he was placed, at a time when the mania of hypothesis was at itsheight, and when the practical part of his art was overrun andstultified by vile and silly nostrums" ("Horae Subsecivae," Vol.I, 4th ed., Edinburgh, 1882, p. 40).

Listen to what he says upon the method of the study of medicine:"In writing therefore, such a natural history of diseases, everymerely philosophical hypothesis should be set aside, and themanifest and natural phenomena, however minute, should be notedwith the utmost exactness. The usefulness of this procedurecannot be easily overrated, as compared with the subtle inquiries

and trifling notions of modern writers, for can there be ashorter, or indeed any other way of coming at the morbificcauses, or discovering the curative indications than by a certainperception of the peculiar symptoms? By these steps and helps itwas that the father of physic, the great Hippocrates, came toexcel, his theory being no more than an exact description or viewof nature. He found that nature alone often terminates diseases,and works a cure with a few simple medicines, and often enoughwith no medicines at all."

Towards the end of the century many great clinical teachersarose, of whom perhaps the most famous was Boerhaave, oftenspoken of as the Dutch Hippocrates, who inspired a group ofdistinguished students. I have already referred to the fact thatFranciscus Sylvius at Leyden was the first among the moderns toorganize systematic clinical teaching. Under Boerhaave, this wasso developed that to this Dutch university students flocked fromall parts of Europe. After teaching botany and chemistry,Boerhaave succeeded to the chair of physic in 1714. With anunusually wide general training, a profound knowledge of thechemistry of the day and an accurate acquaintance with allaspects of the history of the profession, he had a stronglyobjective attitude of mind towards disease, following closely themethods of Hippocrates and Sydenham. He adopted no specialsystem, but studied disease as one of the phenomena of nature.His clinical lectures, held bi-weekly, became exceedingly popularand were made attractive not less by the accuracy and care withwhich the cases were studied than by the freedom from fancifuldoctrines and the frank honesty of the man. He was much greaterthan his published work would indicate, and, as is the case withmany teachers of the first rank, his greatest contributions werehis pupils. No other teacher of modern times has had such afollowing. Among his favorite pupils may be mentioned Haller, thephysiologist, and van Swieten and de Haen, the founders of theVienna school.

In Italy, too, there were men who caught the new spirit, andappreciated the value of combining morbid anatomy with clinicalmedicine. Lancisi, one of the early students of disease of theheart, left an excellent monograph on the subject, and was thefirst to call special attention to the association of syphiliswith cardio-vascular disease. A younger contemporary of his atRome, Baglivi, was unceasing in his call to the profession toreturn to Hippocratic methods, to stop reading philosophicaltheories and to give up what he calls the "fatal itch" to makesystems.

The Leyden methods of instruction were carried far and widethroughout Europe; into Edinburgh by John Rutherford, who beganto teach at the Royal Infirmary in 1747, and was followed byWhytt and by Cullen; into England by William Saunders of Guy'sHospital. Unfortunately the great majority of clinicians couldnot get away from the theoretical conceptions of disease, andCullen's theory of spasm and atony exercised a profound influenceon practice, particularly in this country, where it had the warmadvocacy of Benjamin Rush. Even more widespread became thetheories of a pupil of Cullen's, John Brown, who regarded

excitability as the fundamental property of all living creatures:too much of this excitability produced what were known as sthenicmaladies, too little, asthenic; on which principles practice wasplain enough. Few systems of medicine have ever stirred suchbitter controversy, particularly on the Continent, and in CharlesCreighton's account of Brown[7] we read that as late as 1802 theUniversity of Gottingen was so convulsed by controversies as tothe merits of the Brunonian system that contending factions ofstudents in enormous numbers, not unaided by the professors, metin combat in the streets on two consecutive days and had to bedispersed by a troop of Hanoverian horse.

[7] Dictionary of National Biography, London, 1886, VII, 14-17.

But the man who combined the qualities of Vesalius, Harvey andMorgagni in an extraordinary personality was John Hunter. Hewas, in the first place, a naturalist to whom pathologicalprocesses were only a small part of a stupendous whole, governedby law, which, however, could never be understood until the factshad been accumulated, tabulated and systematized. By his example,by his prodigious industry, and by his suggestive experiments heled men again into the old paths of Aristotle, Galen and Harvey.He made all thinking physicians naturalists, and he lent adignity to the study of organic life, and re-established a closeunion between medicine and the natural sciences. Both in Britainand Greater Britain, he laid the foundation of the greatcollections and museums, particularly those connected with themedical schools. The Wistar-Horner and the Warren Museums in thiscountry originated with men greatly influenced by Hunter. Hewas, moreover, the intellectual father of that interesting groupof men on this side of the Atlantic who, while practising asphysicians, devoted much time and labor to the study of naturalhistory; such men as Benjamin Smith Barton, David Hossack, JacobBigelow, Richard Harlan, John D. Godman, Samuel George Morton,John Collins Warren, Samuel L. Mitchill and J. Ailken Meigs. Hegave an immense impetus in Great Britain to the study of morbidanatomy, and his nephew, Matthew Baillie, published the firstimportant book on the subject in the English language.

Before the eighteenth century closed practical medicine had madegreat advance. Smallpox, though not one of the great scourgeslike plague or cholera, was a prevalent and much dreaded disease,and in civilized countries few reached adult life without anattack. Edward Jenner, a practitioner in Gloucestershire, and thepupil to whom John Hunter gave the famous advice: "Don't think,try!" had noticed that milkmaids who had been infected withcowpox from the udder of the cow were insusceptible to smallpox.I show you here the hand of Sarah Nelmes with cowpox, 1796. Avague notion had prevailed among the dairies from time immemorialthat this disease was a preventive of the smallpox. Jenner putthe matter to the test of experiment. Let me quote here his ownwords: "The first experiment was made upon a lad of the name ofPhipps, in whose arm a little vaccine virus was inserted, takenfrom the hand of a young woman who had been accidentally infectedby a cow. Notwithstanding the resemblance which the pustule,thus excited on the boy's arm, bore to variolous inoculation, yet

as the indisposition attending it was barely perceptible, I couldscarcely persuade myself the patient was secure from the SmallPox. However, on his being inoculated some months afterwards, itproved that he was secure."[8] The results of his experimentswere published in a famous small quarto volume in 1798.[*] Fromthis date, smallpox has been under control. Thanks to Jenner, nota single person in this audience is pockmarked! A hundred andtwenty-five years ago, the faces of more than half of you wouldhave been scarred. We now know the principle upon whichprotection is secured: an active acquired immunity follows uponan attack of a disease of a similar nature. Smallpox and cowpoxare closely allied and the substances formed in the blood by theone are resistant to the virus of the other. I do not see how anyreasonable person can oppose vaccination or decry its benefits.I show you the mortality figures[9] of the Prussian Army and ofthe German Empire. A comparison with the statistics of thearmies of other European countries in which revaccination is notso thoroughly carried out is most convincing of its efficacy.

[8] Edward Jenner: The Origin of the Vaccine Inoculation,London, 1801.

[*] Reprinted by Camac: Epoch-making Contributions to Medicine,etc., 1909.--Ed.

[9] Jockmann: Pocken und Vaccinationlehre, 1913.

The early years of the century saw the rise of modern clinicalmedicine in Paris. In the art of observation men had come to astandstill. I doubt very much whether Corvisart in 1800 was anymore skilful in recognizing a case of pneumonia than was Aretaeusin the second century A. D. But disease had come to be moresystematically studied; special clinics were organized, andteaching became much more thorough. Anyone who wishes to have apicture of the medical schools in Europe in the first few yearsof the century, should read the account of the travels of JosephFrank of Vienna.[10] The description of Corvisart is of a pioneerin clinical teaching whose method remains in vogue today inFrance--the ward visit, followed by a systematic lecture in theamphitheatre. There were still lectures on Hippocrates threetimes a week, and bleeding was the principal plan of treatment:one morning Frank saw thirty patients, out of one hundred andtwelve, bled! Corvisart was the strong clinician of hisgeneration, and his accurate studies on the heart were among thefirst that had concentrated attention upon a special organ. Tohim, too, is due the reintroduction of the art of percussion ininternal disease discovered by Auenbrugger in 1761.

[10] Joseph Frank: Reise nach Paris [etc.], Wien, 1804-05.

The man who gave the greatest impetus to the study of scientificmedicine at this time was Bichat, who pointed out that thepathological changes in disease were not so much in organs as intissues. His studies laid the foundation of modern histology. Heseparated the chief constituent elements of the body into various

tissues possessing definite physical and vital qualities."Sensibility and contractability are the fundamental qualities ofliving matter and of the life of our tissues. Thus Bichatsubstituted for vital forces 'vital properties,' that is to say,a series of vital forces inherent in the different tissues."[11]His "Anatomic Generale," published in 1802, gave an extraordinarystimulus to the study of the finer processes of disease, and hisfamous "Recherches sur la Vie et sur la Mort" (1800) dealt adeath-blow to old iatromechanical and iatrochemical views. Hiscelebrated definition may be quoted: "La vie est l'ensemble desproprietes vitales qui resistent aux proprietes physiques, oubien la vie est l'ensemble des fonctions qui resistent a lamort." (Life is the sum of the vital properties that withstandthe physical properties, or, life is the sum of the functionsthat withstand death.) Bichat is another pathetic figure inmedical history. His meteoric career ended in his thirty-firstyear: he died a victim of a post-mortem wound infection. At hisdeath, Corvisart wrote Napoleon: "Bichat has just died at theage of thirty. That battlefield on which he fell is one whichdemands courage and claims many victims. He has advanced thescience of medicine. No one at his age has done so much so well."

[11] E. Boinet: Les doctrines medicules, leur evolution, Paris,1907, pp. 85-86.

It was a pupil of Corvisart, Rene Theophile Laennec, who laid thefoundation of modern clinical medicine. The story of his life iswell known. A Breton by birth, he had a hard, up-hill struggleas a young man--a struggle of which we have only recently beenmade aware by the publication of a charming book by ProfessorRouxeau of Nantes--"Laennec avant 1806." Influenced byCorvisart, he began to combine the accurate study of cases in thewards with anatomical investigations in the dead-house. BeforeLaennec, the examination of a patient had been largely by senseof sight, supplemented by that of touch, as in estimating thedegree of fever, or the character of the pulse. Auenbrugger's"Inventum novum" of percussion, recognized by Corvisart, extendedthe field; but the discovery of auscultation by Laennec, and thepublication of his work--"De l'Auscultation Mediate,"1819,--marked an era in the study of medicine. The clinicalrecognition of individual diseases had made really very littleprogress; with the stethoscope begins the day of physicaldiagnosis. The clinical pathology of the heart, lungs and abdomenwas revolutionized. Laennec's book is in the category of theeight or ten greatest contributions to the science ofmedicine.[*] His description of tuberculosis is perhaps the mostmasterly chapter in clinical medicine. This revolution waseffected by a simple extension of the Hippocratic method from thebed to the dead-house, and by correlating the signs and symptomsof a disease with its anatomical appearances.

[*] John Forbes's translation of Auenbrugger and part of histranslation of Lacnnec are reprinted in Camac's Epoch-makingContributions, etc., 1909.--Ed.

The pupils and successors of Corvisart--Bayle, Andral, Bouillaud,Chomel, Piorry, Bretonneau, Rayer, Cruveilhier and Trousseau--brought a new spirit into the profession. Everywhere theinvestigation of disease by clinical-pathological methods widenedenormously the diagnostic powers of the physician. By this methodRichard Bright, in 1836, opened a new chapter on the relation ofdisease of the kidney to dropsy, and to albuminous urine. It hadalready been shown by Blackwell and by Wells, the celebratedCharleston (S.C.) physician, in 1811, that the urine containedalbumin in many cases of dropsy, but it was not until Brightbegan a careful investigation of the bodies of patients who hadpresented these symptoms, that he discovered the association ofvarious forms of disease of the kidney with anasarca andalbuminous urine. In no direction was the harvest of thiscombined study more abundant than in the complicated and confusedsubject of fever. The work of Louis and of his pupils, W.W.Gerhard and others, revealed the distinction between typhus andtyphoid fever, and so cleared up one of the most obscure problemsin pathology. By Morgagni's method of "anatomical thinking,"Skoda in Vienna, Schonlein in Berlin, Graves and Stokes inDublin, Marshall Hall, C. J. B. Williams and many othersintroduced the new and exact methods of the French and created anew clinical medicine. A very strong impetus was given by theresearches of Virchow on cellular pathology, which removed theseats of disease from the tissues, as taught by Bichat, to theindividual elements, the cells. The introduction of the use ofthe microscope in clinical work widened greatly our powers ofdiagnosis, and we obtained thereby a very much clearer conceptionof the actual processes of disease. In another way, too, medicinewas greatly helped by the rise of experimental pathology, whichhad been introduced by John Hunter, was carried along by Magendieand others, and reached its culmination in the epoch-makingresearches of Claude Bernard. Not only were valuable studiesmade on the action of drugs, but also our knowledge of cardiacpathology was revolutionized by the work of Traube, Cohnheim andothers. In no direction did the experimental method effect such arevolution as in our knowledge of the functions of the brain.Clinical neurology, which had received a great impetus by thestudies of Todd, Romberg, Lockhart Clarke, Duchenne and WeirMitchell, was completely revolutionized by the experimental workof Hitzig, Fritsch and Ferrier on the localization of functionsin the brain. Under Charcot, the school of French neurologistsgave great accuracy to the diagnosis of obscure affections of thebrain and spinal cord, and the combined results of the newanatomical, physiological and experimental work have renderedclear and definite what was formerly the most obscure andcomplicated section of internal medicine. The end of the fifthdecade of the century is marked by a discovery of supremeimportance. Humphry Davy had noted the effects of nitrous oxide.The exhilarating influence of sulphuric ether had been casuallystudied, and Long of Georgia had made patients inhale the vaporuntil anaesthetic and had performed operations upon them when inthis state; but it was not until October 16, 1846, in theMassachusetts General Hospital, that Morton, in a publicoperating room, rendered a patient insensible with ether anddemonstrated the utility of surgical anaesthesia. The rivalclaims of priority no longer interest us, but the occasion is one

of the most memorable in the history of the race. It is well thatour colleagues celebrate Ether Day in Boston-- no more preciousboon has ever been granted to suffering humanity.[*]

[*] Cf. Osler: Proc. Roy. Soc. Med., XI, Sect. Hist. Med., pp.65-69, 1918, or, Annals Med. Hist., N.Y., I, 329-332. Cf. alsoMorton's publications reprinted in Camac's book cited above.--Ed.

In 1857, a young man, Louis Pasteur, sent to the Lille ScientificSociety a paper on "Lactic Acid Fermentation" and in December ofthe same year presented to the Academy of Sciences in Paris apaper on "Alcoholic Fermentation" in which he concluded that "thededuplication of sugar into alcohol and carbonic acid iscorrelative to a phenomenon of life." A new era in medicine datesfrom those two publications. The story of Pasteur's life shouldbe read by every student.[*] It is one of the glories of humanliterature, and, as a record of achievement and of nobility ofcharacter, is almost without an equal.

[*] Osler wrote a preface for the 1911 English edition of theLife by Vallery-Radot.--Ed.

At the middle of the last century we did not know much more ofthe actual causes of the great scourges of the race, the plagues,the fevers and the pestilences, than did the Greeks. Here comesPasteur's great work. Before him Egyptian darkness; with hisadvent a light that brightens more and more as the years give usever fuller knowledge. The facts that fevers were catching, thatepidemics spread, that infection could remain attached toarticles of clothing, etc., all gave support to the view that theactual cause was something alive, a contagium vivum. It wasreally a very old view, the germs of which may be found in theFathers, but which was first clearly expressed--so far as Iknow--by Fracastorius, the Veronese physician, in the sixteenthcentury, who spoke of the seeds of contagion passing from oneperson to another;[12] and he first drew a parallel between theprocesses of contagion and the fermentation of wine. This wasmore than one hundred years before Kircher, Leeuwenhoek andothers began to use the microscope and to see animalcula,, etc.,in water, and so give a basis for the "infinitely little" view ofthe nature of disease germs. And it was a study of the processesof fermentation that led Pasteur to the sure ground on which wenow stand.

[12] Varro, in De Re Rustica, Bk. I, 12 (circa 40 B.C.), speaksof minute organisms which the eye cannot see and which enter thebody and cause disease.

Out of these researches arose a famous battle which kept Pasteurhard at work for four or five years--the struggle overspontaneous generation. It was an old warfare, but the microscopehad revealed a new world, and the experiments on fermentation hadlent great weight to the omne vivum ex ovo doctrine. The famousItalians, Redi and Spallanzani, had led the way in their

experiments, and the latter had reached the conclusion that thereis no vegetable and no animal that has not its own germ. Butheterogenesis became the burning question, and Pouchet in France,and Bastian in England, led the opposition to Pasteur. The manyfamous experiments carried conviction to the minds of scientificmen, and destroyed forever the old belief in spontaneousgeneration. All along, the analogy between disease andfermentation must have been in Pasteur's mind; and then came thesuggestion, "What would be most desirable is to push thosestudies far enough to prepare the road for a serious researchinto the origin of various diseases." If the changes in lactic,alcoholic and butyric fermentations are due to minute livingorganisms, why should not the same tiny creatures make thechanges which occur in the body in the putrid and suppurativediseases? With an accurate training as a chemist, having beendiverted in his studies upon fermentation into the realm ofbiology, and nourishing a strong conviction of the identitybetween putrefactive changes of the body and fermentation,Pasteur was well prepared to undertake investigations which hadhitherto been confined to physicians alone.

So impressed was he with the analogy between fermentation and theinfectious diseases that, in 1863, he assured the French Emperorof his ambition "to arrive at the knowledge of the causes ofputrid and contagious diseases." After a study upon the diseasesof wines, which has had most important practical bearings, anopportunity arose which changed the whole course of his career,and profoundly influenced the development of medical science. Adisease of the silkworm had, for some years, ruined one of themost important industries in France, and in 1865 the Governmentasked Pasteur to give up his laboratory work and teaching, and todevote his whole energies to the task of investigating it. Thestory of the brilliant success which followed years ofapplication to the problem will be read with deep interest byevery student of science. It was the first of his victories inthe application of the experimental methods of a trained chemistto the problems of biology, and it placed his name high in thegroup of the most illustrious benefactors of practicalindustries.

In a series of studies on the diseases of beer, and on the modeof production of vinegar, he became more and more convinced thatthese studies on fermentation had given him the key to the natureof the infectious diseases. It is a remarkable fact that thedistinguished English philosopher of the seventeenth century, theman who more than anyone else of his century appreciated theimportance of the experimental method, Robert Boyle, had saidthat he who could discover the nature of ferments andfermentation, would be more capable than anyone else ofexplaining the nature of certain diseases.

In 1876 there appeared in Cohn's "Beitrage zur Morphologie derPflanzen" (II, 277-310), a paper on the "AEtiology of Anthrax" bya German district physician in Wollstein, Robert Koch, which ismemorable in our literature as the starting point of a new methodof research into the causation of infectious diseases. Kochdemonstrated the constant presence of germs in the blood of

animals dying from the disease. Years before, those organismshad been seen by Pollender and Davaine, but the epoch-makingadvance of Koch was to grow those organisms in a pure cultureoutside the body, and to produce the disease artificially byinoculating animals with the cultures Koch is really our medicalGalileo, who, by means of a new technique,--pure cultures andisolated staining,-- introduced us to a new world. In 1878,followed his study on the "AEtiology of Wound Infections," inwhich he was able to demonstrate conclusively the association ofmicro-organisms with the disease. Upon those two memorableresearches made by a country doctor rests the modern science ofbacteriology.

The next great advance was the discovery by Pasteur of thepossibility of so attenuating, or weakening, the poison that ananimal inoculated had a slight attack, recovered and was thenprotected against the disease. More than eighty years had passedsince on May 14, 1796, Jenner had vaccinated a child with cowpoxand proved that a slight attack of one disease protected the bodyfrom a disease of an allied nature. An occasion equally famous inthe history of medicine was a day in 1881, when Pasteurdetermined that a flock of sheep vaccinated with the attenuatedvirus of anthrax remained well, when every one of theunvaccinated infected from the same material had died.Meanwhile, from Pasteur's researches on fermentation andspontaneous generation, a transformation had been initiated inthe practice of surgery, which, it is not too much to say, hasproved one of the greatest boons ever conferred upon humanity. Ithad long been recognized that, now and again, a wound healedwithout the formation of pus, that is, without suppuration, butboth spontaneous and operative wounds were almost invariablyassociated with that process; and, moreover, they frequentlybecame putrid, as it was then called,--infected, as we shouldsay,--the general system became involved and the patient died ofblood poisoning. So common was this, particularly in old,ill-equipped hospitals, that many surgeons feared to operate, andthe general mortality in all surgical cases was very high.Believing that it was from outside that the germs came whichcaused the decomposition of wounds, just as from the atmospherethe sugar solution got the germs which caused the fermentation, ayoung surgeon in Glasgow, Joseph Lister, applied the principlesof Pasteur's experiments to their treatment. From Lister'soriginal paper[*] I quote the following: "Turning now to thequestion how the atmosphere produces decomposition of organicsubstances, we find that a flood of light has been thrown uponthis most important subject by the philosophic researches of M.Pasteur, who has demonstrated by thoroughly convincing evidencethat it is not to its oxygen or to any of its gaseousconstituents that the air owes this property, but to minuteparticles suspended in it, which are the germs of various lowforms of life, long since revealed by the microscope, andregarded as merely accidental concomitants of putrescence, butnow shown by Pasteur to be its essential cause, resolving thecomplex organic compounds into substances of simpler chemicalconstitution, just as the yeast-plant converts sugar into alcoholand carbonic acid." From these beginnings modern surgery took itsrise, and the whole subject of wound infection, not only in

relation to surgical diseases, but to child-bed fever, forms nowone of the most brilliant chapters in the history of preventivemedicine.

[*] Lancet, March 16, 1867. [Cf. Camac: Epoch-makingContributions, etc., 1909, p. 7.--Ed.]

With the new technique and experimental methods, the discovery ofthe specific germs of many of the more important acute infectionsfollowed each other with bewildering rapidity: typhoid fever,diphtheria, cholera, tetanus, plague, pneumonia, gonorrhoea and,most important of all, tuberculosis. It is not too much to saythat the demonstration by Koch of the "bacillus tuberculosis"(1882) is, in its far-reaching results, one of the most momentousdiscoveries ever made.

Of almost equal value have been the researches upon the protozoanforms of animal life, as causes of disease. As early as 1873,spirilla were demonstrated in relapsing fever. Laveran proved theassociation of haematozoa with malaria in 1880. In the same year,Griffith Evans discovered trypanosomes in a disease of horses andcattle in India, and the same type of parasite was found in thesleeping sickness. Amoebae were demonstrated in one form ofdysentery, and in other tropical diseases protozoa werediscovered, so that we were really prepared for the announcementin 1905, by Schaudinn, of the discovery of a protozoan parasitein syphilis. Just fifty years had passed since Pasteur had sentin his paper on "Lactic Acid Fermentation" to the LilleScientific Society--half a century in which more had been done todetermine the true nature of disease than in all the time thathad passed since Hippocrates. Celsus makes the oft-quoted remarkthat to determine the cause of a disease often leads to theremedy,[*] and it is the possibility of removing the cause thatgives such importance to the new researches on disease.

[*] "Et causae quoque estimatio saepe morbum solvit," Celsus,Lib. I, Prefatio.--Ed.

INTERNAL SECRETIONS

ONE of the greatest contributions of the nineteenth century toscientific medicine was the discovery of the internal secretionsof organs. The basic work on the subject was done by ClaudeBernard, a pupil of the great Magendie, whose saying it is wellto remember--"When entering a laboratory one should leavetheories in the cloakroom." More than any other man of hisgeneration, Claude Bernard appreciated the importance ofexperiment in practical medicine. For him the experimentalphysician was the physician of the future-- a view well borne outby the influence his epoch-making work has had on the treatmentof disease. His studies on the glycogenic functions of the liveropened the way for the modern fruitful researches on the internalsecretions of the various glands. About the same time thatBernard was developing the laboratory side of the problem,Addison, a physician to Guy's Hospital, in 1855, pointed out the

relation of a remarkable group of symptoms to disease of thesuprarenal glands, small bodies situated above the kidneys, theimportance of which had not been previously recognized. With theloss of the function of these glands by disease, the body wasdeprived of something formed by them which was essential to itsproper working. Then, in the last third of the century, came inrapid succession the demonstration of the relations of thepancreas to diabetes, of the vital importance of the thyroidgland and of the pituitary body. Perhaps no more strikingillustration of the value of experimental medicine has ever beengiven than that afforded by the studies upon those glands.

The thyroid body, situated in the neck and the enlargement ofwhich is called goitre, secretes substances which pass into theblood, and which are necessary for the growth of the body inchildhood, for the development of the mind and for the nutritionof the tissues of the skin. If, following an infectious disease,a child has wasting of this gland, or if, living in a certaindistrict, it has a large goitre, normal development does not takeplace, and the child does not grow in mind or body and becomeswhat is called a cretin. More than this--if in adult life thegland is completely removed, or if it wastes, a somewhat similarcondition is produced, and the patient in time loses his mentalpowers and becomes fat and flabby--myxedematous. It has beenshown experimentally in various ways that the necessary elementsof the secretion can be furnished by feeding with the gland orits extracts, and that the cretinoid or myxedematous conditionscould thus be cured or prevented.

Experimental work has also demonstrated the functions of thesuprarenal glands and explained the symptoms of Addison'sdisease, and chemists have even succeeded in making syntheticallythe active principle adrenalin.

There is perhaps no more fascinating story in the history ofscience than that of the discovery of these so-called ductlessglands. Part of its special interest is due to the fact thatclinicians, surgeons, experimental physiologists, pathologistsand chemists have all combined in splendid teamwork to win thevictory. No such miracles have ever before been wrought byphysicians as those which we see in connection with the internalsecretion of the thyroid gland. The myth of bringing the deadback to life has been associated with the names of many greathealers since the incident of Empedocles and Pantheia, butnowadays the dead in mind and the deformed in body may berestored by the touch of the magic wand of science. The study ofthe interaction of these internal secretions, their influenceupon development, upon mental process and upon disorders ofmetabolism is likely to prove in the future of a benefit scarcelyless remarkable than that which we have traced in the infectiousdiseases.

CHEMISTRY

IT is not making too strong a statement to say that the chemistryand chemical physics of the nineteenth century have

revolutionized the world. It is difficult to realize thatLiebig's famous Giessen laboratory, the first to be opened tostudents for practical study, was founded in the year 1825.Boyle, Cavendish, Priestley, Lavoisier, Black, Dalton and othershad laid a broad foundation, and Young, Frauenhofer, Rumford,Davy, Joule, Faraday, Clerk-Maxwell, Helmholtz and others builtupon that and gave us the new physics and made possible our ageof electricity. New technique and new methods have given apowerful stimulus to the study of the chemical changes that takeplace in the body, which, only a few years ago, were matterslargely of speculation. "Now," in the words of Professor Lee,"we recognize that, with its living and its non-living substancesinextricably intermingled, the body constitutes an intensivechemical laboratory in which there is ever occurring a vastcongeries of chemical reactions; both constructive anddestructive processes go on; new protoplasm takes the place ofold. We can analyze the income of the body and we can analyze itsoutput, and from these data we can learn much concerning thebody's chemistry. A great improvement in the method of such workhas recently been secured by the device of inclosing the personwho is the subject of the experiment in a respirationcalorimeter. This is an air-tight chamber, artificially suppliedwith a constant stream of pure air, and from which the expiredair, laden with the products of respiration, is withdrawn forpurposes of analysis. The subject may remain in the chamber fordays, the composition of all food and all excrete beingdetermined, and all heat that is given off being measured.Favorable conditions are thus established for an exact study ofmany problems of nutrition. The difficulties increase when weattempt to trace the successive steps in the corporeal pathway ofmolecule and atom. Yet these secrets of the vital process arealso gradually being revealed. When we remember that it is inthis very field of nutrition that there exist great popularignorance and a special proneness to fad and prejudice, werealize how practically helpful are such exact studies ofmetabolism."[13]

[13] Frederick S. Lee, Ph.D.: Scientific Features of ModernMedicine, New York, 1911. I would like to call attention to thiswork of Professor Lee's as presenting all the scientific featuresof modern medicine in a way admirably adapted for anyone, lay ormedical, who wishes to get a clear sketch of them.

CHAPTER VI

THE RISE OF PREVENTIVE MEDICINE

THE story so far has been of men and of movements--of men whohave, consciously or unconsciously, initiated great movements,and of movements by which, nolens volens, the men of the timewere moulded and controlled. Hippocrates, in the tractate on"Ancient Medicine," has a splendid paragraph on the attitude ofmind towards the men of the past. My attention was called to itone day in the Roman Forum by Commendatore Boni, who quoted it asone of the great sayings of antiquity. Here it is: "But on that

account, I say, we ought not to reject the ancient Art, as if itwere not, and had not been properly founded, because it did notattain accuracy in all things, but rather, since it is capable ofreaching to the greatest exactitude by reasoning, to receive itand admire its discoveries, made from a state of great ignorance,and as having been well and properly made, and not fromchance."[1]

[1] The Works of Hippocrates, Adams, Vol. I, p. 168, London, 1849(Sydenham Society).

I have tried to tell you what the best of these men in successiveages knew, to show you their point of outlook on the things thatinterest us. To understand the old writers one must see as theysaw, feel as they felt, believe as they believed--and this ishard, indeed impossible! We may get near them by asking theSpirit of the Age in which they lived to enter in and dwell withus, but it does not always come. Literary criticism is notliterary history--we have no use here for the former, but toanalyze his writings is to get as far as we can behind the doorsof a man's mind, to know and appraise his knowledge, not from ourstandpoint, but from that of his contemporaries, his predecessorsand his immediate successors. Each generation has its ownproblems to face, looks at truth from a special focus and doesnot see quite the same outlines as any other. For example, men ofthe present generation grow up under influences very differentfrom those which surrounded my generation in the seventies of thelast century, when Virchow and his great contemporaries laid thesure and deep foundations of modern pathology. Which of you nowknows the "Cellular Pathology" as we did? To many of you it is aclosed book,--to many more Virchow may be thought a spent force.But no, he has only taken his place in a great galaxy. We do notforget the magnitude of his labors, but a new generation has newproblems--his message was not for you--but that medicine todayruns in larger moulds and turns out finer castings is due to hislife and work. It is one of the values of lectures on the historyof medicine to keep alive the good influences of great men evenafter their positive teaching is antiquated. Let no man be sofoolish as to think that he has exhausted any subject for hisgeneration. Virchow was not happy when he saw the young men pourinto the old bottle of cellular pathology the new wine ofbacteriology. Lister could never understand how aseptic surgeryarose out of his work. Ehrlich would not recognize hisepoch-making views on immunity when this generation has finishedwith them. I believe it was Hegel who said that progress is aseries of negations--the denial today of what was acceptedyesterday, the contradiction by each generation of some part atleast of the philosophy of the last; but all is not lost, thegerm plasm remains, a nucleus of truth to be fertilized by menoften ignorant even of the body from which it has come.Knowledge evolves, but in such a way that its possessors arenever in sure possession. "It is because science is sure ofnothing that it is always advancing" (Duclaux).

History is the biography of the mind of man, and its educationalvalue is in direct proportion to the completeness of our study of

the individuals through whom this mind has been manifested. Ihave tried to take you back to the beginnings of science, and totrace its gradual development, which is conditioned by threelaws. In the first place, like a living organism, truth grows,and its gradual evolution may be traced from the tiny germ to themature product. Never springing, Minerva-like, to full stature atonce, truth may suffer all the hazards incident to generation andgestation. Much of history is a record of the mishaps of truthswhich have struggled to the birth, only to die or else to witherin premature decay. Or the germ may be dormant for centuries,awaiting the fullness of time.

Secondly, all scientific truth is conditioned by the state ofknowledge at the time of its announcement. Thus, at thebeginning of the seventeenth century, the science of optics andmechanical appliances had not made possible (so far as the humanmind was concerned) the existence of blood capillaries and bloodcorpuscles. Jenner could not have added to his "Inquiry" a studyon immunity; Sir William Perkin and the chemists made Kochtechnique possible; Pasteur gave the conditions that producedLister; Davy and others furnished the preliminaries necessary foranaesthesia. Everywhere we find this filiation, one eventfollowing the other in orderly sequence--"Mind begets mind," asHarvey (De Generatione) says; "opinion is the source of opinion.Democritus with his atoms, and Eudoxus with his chief good whichhe placed in pleasure, impregnated Epicurus; the four elements ofEmpedocles, Aristotle; the doctrines of the ancient Thebans,Pythagoras and Plato; geometry, Euclid."[2]

[2] Works of William Harvey, translated by Robert Willis, London,1847, p. 532.

And, thirdly, to scientific truth alone may the homo mensuraprinciple be applied, since of all mental treasures of the raceit alone compels general acquiescence. That this generalacquiescence, this aspect of certainty, is not reached persaltum, but is of slow, often of difficult growth,--marked byfailures and frailties, but crowned at last with an acceptanceaccorded to no other product of mental activity,--is illustratedby every important discovery from Copernicus to Darwin.

The difficulty is to get men to the thinking level which compelsthe application of scientific truths. Protagoras, that"mighty-wise man," as Socrates called him, who was responsiblefor the aphorism that man is the measure of all things, wouldhave been the first to recognize the folly of this standard forthe people at large. But we have gradually reached a stage inwhich knowledge is translated into action, made helpful forsuffering humanity, just as the great discoveries in physics andchemistry have been made useful in the advance of civilization.We have traced medicine through a series of upward steps-- aprimitive stage, in which it emerged from magic and religion intoan empirical art, as seen among the Egyptians and Babylonians; astage in which the natural character of disease was recognizedand the importance of its study as a phenomenon of nature wasannounced; a stage in which the structure and functions of the

human body were worked out; a stage in which the clinical andanatomical features of disease were determined; a stage in whichthe causes of disorders were profitably studied, and a finalstage, into which we have just entered, the application of theknowledge for their prevention. Science has completely changedman's attitude towards disease.

Take a recent concrete illustration. A couple of years ago inPhiladelphia and in some other parts of the United States, a verypeculiar disease appeared, characterized by a rash upon the skinand moderate fever, and a constitutional disturbanceproportionate to the extent and severity of the eruption. Themalady first broke out in the members of a crew of a privateyacht; then in the crews of other boats, and among persons livingin the boarding-houses along the docks. It was the cause of agreat deal of suffering and disability.

There were three courses open: to accept the disease as avisitation of God, a chastening affliction sent from above, andto call to aid the spiritual arm of the church. Except the"Peculiar People" few now take this view or adopt this practice.The Christian Scientist would probably deny the existence of therash and of the fever, refuse to recognize the itching and gethimself into harmony with the Infinite. Thirdly, the method ofexperimental medicine.

First, the conditions were studied under which the individualcases occurred. The only common factor seemed to be certain strawmattresses manufactured by four different firms, all of whichobtained the straw from the same source.

The second point was to determine the relation of the straw tothe rash. One of the investigators exposed a bare arm andshoulder for an hour between two mattresses. Three peoplevoluntarily slept on the mattresses for one night. Siftings fromthe straw were applied to the arm, under all of whichcircumstances the rash quickly developed, showing conclusivelythe relation of the straw to the disease.

Thirdly, siftings from the straw and mattresses which had beenthoroughly disinfected failed to produce the rash.

And fourthly, careful inspection of the siftings of the strawdisclosed living parasites, small mites, which when applied tothe skin quickly produced the characteristic eruption.

SANITATION

WHEN the thoughtful historian gets far enough away from thenineteenth century to see it as a whole, no single feature willstand out with greater distinctness than the fulfilment of theprophecy of Descartes that we could be freed from an infinity ofmaladies both of body and mind if we had sufficient knowledge oftheir causes and of all the remedies with which nature hasprovided us. Sanitation takes its place among the great modernrevolutions-- political, social and intellectual. Great Britain

deserves the credit for the first practical recognition of themaxim salus populi suprema lex. In the middle and latter part ofthe century a remarkable group of men, Southwood Smith, Chadwick,Budd, Murchison, Simon, Acland, Buchanan, J.W. Russell andBenjamin Ward Richardson, put practical sanitation on ascientific basis. Even before the full demonstration of the germtheory, they had grasped the conception that the battle had to befought against a living contagion which found in poverty, filthand wretched homes the conditions for its existence. Oneterrible disease was practically wiped out in twenty-five yearsof hard work. It is difficult to realize that within the memoryof men now living, typhus fever was one of the great scourges ofour large cities, and broke out in terrible epidemics--the mostfatal of all to the medical profession. In the severe epidemic inIreland in the forties of the last century, one fifth of all thedoctors in the island died of typhus. A better idea of the newcrusade, made possible by new knowledge, is to be had from aconsideration of certain diseases against which the fight is inactive progress.

Nothing illustrates more clearly the interdependence of thesciences than the reciprocal impulse given to new researches inpathology and entomology by the discovery of the part played byinsects in the transmission of disease. The flea, the louse, thebedbug, the house fly, the mosquito, the tick, have all within afew years taken their places as important transmitters ofdisease. The fly population may be taken as the sanitary index ofa place. The discovery, too, that insects are porters of diseasehas led to a great extension of our knowledge of their lifehistory. Early in the nineties, when Dr. Thayer and I were busywith the study of malaria in Baltimore, we began experiments onthe possible transmission of the parasites, and a tramp, who hadbeen a medical student, offered himself as a subject. Before webegan, Dr. Thayer sought information as to the varieties ofmosquitoes known in America, but sought in vain: there had atthat time been no systematic study. The fundamental study whichset us on the track was a demonstration by Patrick Manson,[3] in1879, of the association of filarian disease with the mosquito.Many observations had already been made, and were madesubsequently, on the importance of insects as intermediary hostsin the animal parasites, but the first really great scientificdemonstration of a widespread infection through insects was byTheobald Smith, now of Harvard University, in 1889, in a study ofTexas fever of cattle.[4] I well remember the deep impressionmade upon me by his original communication, which incompleteness, in accuracy of detail, in Harveian precision and inpractical results remains one of the most brilliant pieces ofexperimental work ever undertaken. It is difficult to drawcomparisons in pathology; but I think, if a census were takenamong the world's workers on disease, the judgment to be based onthe damage to health and direct mortality, the votes would begiven to malaria as the greatest single destroyer of the humanrace. Cholera kills its thousands, plague, in its bad years, itshundreds of thousands, yellow fever, hookworm disease, pneumonia,tuberculosis, are all terribly destructive, some only in thetropics, others in more temperate regions: but malaria is today,as it ever was, a disease to which the word pandemic is specially

applicable. In this country and in Europe, its ravages havelessened enormously during the past century, but in the tropicsit is everywhere and always present, the greatest single foe ofthe white man, and at times and places it assumes the proportionsof a terrible epidemic. In one district of India alone, duringthe last four months of 1908, one quarter of the total populationsuffered from the disease and there were 400,000 deaths--practically all from malaria. Today, the control of thisterrible scourge is in our hands, and, as I shall tell you in afew minutes, largely because of this control, the Panama Canal isbeing built. No disease illustrates better the progressiveevolution of scientific medicine. It is one of the oldest ofknown diseases. The Greeks and Graeco-Romans knew it well. Itseems highly probable, as brought out by the studies of W.H.S.Jones of Cambridge, that, in part at least, the physicaldegeneration in Greece and Rome may have been due to the greatincrease of this disease. Its clinical manifestations were wellknown and admirably described by the older writers. In theseventeenth century, as I have already told you, the remarkablediscovery was made that the bark of the cinchona tree was aspecific. Between the date of the Countess's recovery in Lima andthe year 1880 a colossal literature on the disease hadaccumulated. Literally thousands of workers had studied thevarious aspects of its many problems; the literature of thiscountry, particularly of the Southern States, in the first halfof the last century may be said to be predominantly malarial.Ordinary observation carried on for long centuries had done asmuch as was possible. In 1880, a young French army surgeon,Laveran by name, working in Algiers, found in the microscopicexamination of the blood that there were little bodies in the redblood corpuscles, amoeboid in character, which he believed to bethe germs of the disease. Very little attention at first waspaid to his work, and it is not surprising. It was the old storyof "Wolf, wolf"; there had been so many supposed "germs" that theprofession had become suspicious. Several years elapsed beforeSurgeon-General Sternberg called the attention of theEnglish-speaking world to Laveran's work: it was taken upactively in Italy, and in America by Councilman, Abbott and byothers among us in Baltimore. The result of these widespreadobservations was the confirmation in every respect of Laveran'sdiscovery of the association with malaria of a protozoanparasite. This was step number three. Clinical observation,empirical discovery of the cure, determination of the presence ofa parasite. Two other steps followed rapidly. Another armysurgeon, Ronald Ross, working in India, influenced by the work ofManson, proved that the disease was transmitted by certainvarieties of mosquitoes. Experiments came in to support thestudies in etiology; two of those may be quoted. Mosquitoeswhich had bitten malarial patients in Italy were sent to Londonand there allowed to bite Mr. Manson, son of Dr. Manson. Thisgentleman had not lived out of England, where there is now noacute malaria. He had been a perfectly healthy, strong man. In afew days following the bites of the infected mosquitoes, he had atypical attack of malarial fever.

[3] Journal Linnaean Society, London, 1879, XIV, 304-311.

[4] Medical News, Philadelphia, 1889, LV, 689-693, and monographwith Kilborne, Washington, 1893.

The other experiment, though of a different character, is quiteas convincing. In certain regions about Rome, in the Campania,malaria is so prevalent that, in the autumn, almost everyone inthe district is attacked, particularly if he is a newcomer. Dr.Sambon and a friend lived in this district from June 1 toSeptember 1, 1900. The test was whether they could live in thisexceedingly dangerous climate for the three months withoutcatching malaria, if they used stringent precautions against thebites of mosquitoes. For this purpose the hut in which they livedwas thoroughly wired, and they slept under netting. Both ofthese gentlemen, at the end of the period, had escaped thedisease.

Then came the fifth and final triumph--the prevention of thedisease. The anti-malarial crusade which has been preached by SirRonald Ross and has been carried out successfully on a wholesalescale in Italy and in parts of India and Africa, has reducedenormously the incidence of the disease. Professor Celli ofRome, in his lecture room, has an interesting chart which showsthe reduction in the mortality from malaria in Italy since thepreventive measures have been adopted--the deaths have fallenfrom above 28,000 in 1888 to below 2000 in 1910. There is neededa stirring campaign against the disease throughout the SouthernStates of this country.

The story of yellow fever illustrates one of the greatestpractical triumphs of scientific medicine; indeed, in view of itsfar-reaching commercial consequences, it may range as one of thefirst achievements of the race. Ever since the discovery ofAmerica, the disease has been one of its great scourges,permanently endemic in the Spanish Main, often extending to theSouthern States, occasionally into the North, and notinfrequently it has crossed the Atlantic. The records of theBritish Army in the West Indies show an appalling death rate,chiefly from this disease. At Jamaica, for the twenty yearsending in 1836, the average mortality was 101 per thousand, andin certain instances as high as 178. One of the most dreaded ofall infections, the periods of epidemics in the Southern Stateshave been the occasions of a widespread panic with completeparalysis of commerce. How appalling the mortality is may bejudged from the outbreak in Philadelphia in 1793, when tenthousand people died in three months.[5] The epidemics in Spainin the early part of the nineteenth century were of greatseverity. A glance through La Roche's great book[6] on thesubject soon gives one an idea of the enormous importance of thedisease in the history of the Southern States. Havana, eversince its foundation, had been a hotbed of yellow fever. Thebest minds of the profession had been attracted to a solution ofthe problem, but all in vain. Commission after commission hadbeen appointed, with negative results; various organisms had beendescribed as the cause, and there were sad illustrations of thetragedy associated with investigations undertaken without propertraining or proper technique. By the year 1900, not only had the

ground been cleared, but the work on insect-borne disease byManson and by Ross had given observers an important clue. It hadrepeatedly been suggested that some relation existed between thebites of mosquitoes and the tropical fevers, particularly by thatremarkable student, Nott of Mobile, and the French physician,Beauperthuy. But the first to announce clearly the mosquitotheory of the disease was Carlos Finlay of Havana. Early in thespring of 1900, during the occupation of Cuba by the UnitedStates, a commission appointed by Surgeon-General Sternberg(himself one of the most energetic students of the disease)undertook fresh investigations. Dr. Walter Reed, Professor ofBacteriology in the Army Medical School, was placed in charge:Dr. Carroll of the United States Army, Dr. Agramonte of Havanaand Dr. Jesse W. Lazear were the other members. At the JohnsHopkins Hospital, we were deeply interested in the work, as Dr.Walter Reed was a favorite pupil of Professor Welch, a warmfriend of all of us, and a frequent visitor to our laboratories.Dr. Jesse Lazear, who had been my house physician, had workedwith Dr. Thayer and myself at malaria, and gave up the charge ofmy clinical laboratory to join the commission.

[5] Matthew Carey: A Short Account of the Malignant Fever,Philadelphia, 1793.

[6] R. La Roche: Yellow Fever, 2 vols., Philadelphia, 1855.

Many scientific discoveries have afforded brilliant illustrationsof method in research, but in the work of these men one is at aloss to know which to admire more--the remarkable accuracy andprecision of the experiments, or the heroism of the men--officersand rank and file of the United States Army; they knew all thetime that they were playing with death, and some of them had topay the penalty! The demonstration was successful--beyondperadventure--that yellow fever could be transmitted bymosquitoes, and equally the negative proposition-- that it couldnot be transmitted by fomites. An interval of twelve or moredays was found to be necessary after the mosquito has bitten ayellow fever patient before it is capable of transmitting theinfection. Lazear permitted himself to be bitten by a straymosquito while conducting his experiments in the yellow feverhospital. Bitten on the thirteenth, he sickened on theeighteenth and died on the twenty-fifth of September, but notuntil he had succeeded in showing in two instances thatmosquitoes could convey the infection. He added another to thelong list of members of the profession who have laid down theirlives in search of the causes of disease. Of such men as Lazearand of Myers of the Liverpool Yellow-Fever Commission, Dutton andyoung Manson, may fitly be sung from the noblest of Americanpoems the tribute which Lowell paid to Harvard's sons who fell inthe War of Secession:

Many in sad faith sought for her, Many with crossed hands sighed for her; But these, our brothers, fought for her, At life's dear peril wrought for her, So loved her that they died for her.

Fortunately, the commander-in-chief at the time in Cuba wasGeneral Leonard Wood, who had been an army surgeon, and he wasthe first to appreciate the importance of the discovery. Thesanitation of Havana was placed in the hands of Dr. Gorgas, andwithin nine months the city was cleared of yellow fever, and,with the exception of a slight outbreak after the withdrawal ofthe American troops, has since remained free from a disease whichhad been its scourge for centuries. As General Wood remarked,"Reed's discovery has resulted in the saving of more livesannually than were lost in the Cuban War, and saves thecommercial interest of the world a greater financial loss eachyear than the cost of the Cuban War. He came to Cuba at a timewhen one third of the officers of my staff died of yellow fever,and we were discouraged at the failure of our efforts to controlit." Following the example of Havana other centres were attacked,at Vera Cruz and in Brazil, with the same success, and it is safeto say that now, thanks to the researches of Reed and hiscolleagues, with proper measures, no country need fear aparalyzing outbreak of this once dreaded disease.

The scientific researches in the last two decades of thenineteenth century made possible the completion of the PanamaCanal. The narrow isthmus separating the two great oceans andjoining the two great continents, has borne for four centuries anevil repute as the White Man's Grave. Silent upon a peak ofDarien, stout Cortez with eagle eye had gazed on the Pacific. Asearly as 1520, Saavedra proposed to cut a canal through theIsthmus. There the first city was founded by the conquerors ofthe new world, which still bears the name of Panama. Spaniards,English and French fought along its coasts; to it the founder ofthe Bank of England took his ill-fated colony; Raleigh, Drake,Morgan the buccaneer, and scores of adventurers seeking gold,found in fever an enemy stronger than the Spaniard. For yearsthe plague-stricken Isthmus was abandoned to the negroes and thehalf-breeds, until in 1849, stimulated by the gold fever ofCalifornia, a railway was begun by the American engineers, Tottenand Trautwine, and completed in 1855, a railway every tie ofwhich cost the life of a man. The dream of navigators andpractical engineers was taken in hand by Ferdinand de Lesseps inJanuary, 1881. The story of the French Canal Company is atragedy unparalleled in the history of finance, and, one may add,in the ravages of tropical disease. Yellow fever, malaria,dysentery, typhus, carried off in nine years nearly twentythousand employees. The mortality frequently rose above 100,sometimes to 130, 140 and in September, 1885, it reached theappalling figure of 176.97 per thousand work people. This wasabout the maximum death rate of the British Army in the WestIndies in the nineteenth century.

When, in 1904, the United States undertook to complete the Canal,everyone felt that the success or failure was largely a matter ofsanitary control. The necessary knowledge existed, but under thecircumstances could it be made effective? Many were doubtful.Fortunately, there was at the time in the United States Army aman who had already served an apprenticeship in Cuba, and to whommore than to anyone else was due the disappearance of yellow

fever from that island. To a man, the profession in the UnitedStates felt that could Dr. Gorgas be given full control of thesanitary affairs of the Panama Zone, the health problem, whichmeant the Canal problem, could be solved. There was at first aserious difficulty relating to the necessary administrativecontrol by a sanitary officer. In an interview which Dr. Welchand I had with President Roosevelt, he keenly felt thisdifficulty and promised to do his best to have it rectified. Itis an open secret that at first, as was perhaps only natural,matters did not go very smoothly, and it took a year or more toget properly organized. Yellow fever recurred on the Isthmus in1904 and in the early part of 1905. It was really a colossal taskin itself to undertake the cleaning of the city of Panama, whichhad been for centuries a pest-house, the mortality in which, evenafter the American occupation, reached during one month the rateof 71 per thousand living. There have been a great many brilliantillustrations of the practical application of science inpreserving the health of a community and in saving life, but itis safe to say that, considering the circumstances, the pasthistory, and the extraordinary difficulties to be overcome, thework accomplished by the Isthmian Canal Commission is unique. Theyear 1905 was devoted to organization; yellow fever was got ridof, and at the end of the year the total mortality among thewhites had fallen to 8 per thousand, but among the blacks it wasstill high, 44. For three years, with a progressively increasingstaff which had risen to above 40,000, of whom more than 12,000were white, the death rate progressively fell.

Of the six important tropical diseases, plague, which reached theIsthmus one year, was quickly held in check. Yellow fever, themost dreaded of them all, never recurred. Beri-beri, which in1906 caused sixty-eight deaths, has gradually disappeared. Thehookworm disease, ankylostomiasis, has steadily decreased. Fromthe very outset, malaria has been taken as the measure ofsanitary efficiency. Throughout the French occupation it was thechief enemy to be considered, not only because of its fatality,but on account of the prolonged incapacity following infection.In 1906, out of every 1000 employees there were admitted to thehospital from malaria 821; in 1907, 424; in 1908, 282; in 1912,110; in 1915, 51; in 1917, 14. The fatalities from the diseasehave fallen from 233 in 1906 to 154 in 1907, to 73 in 1908 and to7 in 1914. The death rate for malarial fever per 1000 populationsank from 8.49 in 1906 to 0.11 in 1918. Dysentery, next tomalaria the most serious of the tropical diseases in the Zone,caused 69 deaths in 1906; 48 in 1907; in 1908, with nearly44,000, only 16 deaths, and in 1914, 4.[*] But it is when thegeneral figures are taken that we see the extraordinary reductionthat has taken place. Out of every 1000 engaged in 1908 only athird of the number died that died in 1906, and half the numberthat died in 1907.

[*] Figures for recent years supplied by editors.

In 1914, the death rate from disease among white males had fallento 3.13 per thousand. The rate among the 2674 American women andchildren connected with the Commission was only 9.72 per

thousand. But by far the most gratifying reduction is among theblacks, among whom the rate from disease had fallen to thesurprisingly low figure in 1912 of 8.77 per thousand; in 1906 itwas 47 per thousand. A remarkable result is that in 1908 thecombined tropical diseases--malaria, dysentery andberi-beri--killed fewer than the two great killing diseases ofthe temperate zone, pneumonia and tuberculosis-- 127 in one groupand 137 in the other. The whole story is expressed in two words,EFFECTIVE ORGANIZATION, and the special value of this experimentin sanitation is that it has been made, and made successfully, inone of the great plague spots of the world.

Month by month a little, gray-covered pamphlet was published byColonel Gorgas, a "Report of the Department of Sanitation of theIsthmian Canal Commission." I have been one of the favored towhom it has been sent year by year, and, keenly interested as Ihave always been in infectious diseases, and particularly inmalaria and dysentery, I doubt if anyone has read it morefaithfully. In evidence of the extraordinary advance made insanitation by Gorgas, I give a random example from one of hismonthly reports (1912): In a population of more than 52,000, thedeath rate from disease had fallen to 7.31 per thousand; amongthe whites it was 2.80 and among the colored people 8.77. Notonly is the profession indebted to Colonel Gorgas and his stafffor this remarkable demonstration, but they have offered anexample of thoroughness and efficiency which has won theadmiration of the whole world. As J. B. Bishop, secretary of theIsthmian Canal Commission, has recently said: "The Americansarrived on the Isthmus in the full light of these two invaluablediscoveries [the insect transmission of yellow fever andmalaria]. Scarcely had they begun active work when an outbreak ofyellow fever occurred which caused such a panic throughout theirforce that nothing except the lack of steamship accommodationprevented the flight of the entire body from the Isthmus.Prompt, intelligent and vigorous application of the remediesshown to he effective by the mosquito discoveries not onlychecked the progress of the pest, but banished it forever fromthe Isthmus. In this way, and in this alone, was the building ofthe canal made possible. The supreme credit for its constructiontherefore belongs to the brave men, surgeons of the United StatesArmy, who by their high devotion to duty and to humanity riskedtheir lives in Havana in 1900-1901 to demonstrate the truth ofthe mosquito theory."[7]

[7] Bishop: The French at Panama, Scribner's Magazine, January,1913, p. 42.

One disease has still a special claim upon the public in thiscountry. Some fourteen or fifteen years ago, in an address on theproblem of typhoid fever in the United States, I contended thatthe question was no longer in the hands of the profession. Inseason and out of season we had preached salvation from it involumes which fill state reports, public health journals and themedical periodicals. Though much has been done, typhoid feverremains a question of grave national concern. You lost in thisstate[7a] in 1911 from typhoid fever 154 lives, every one

sacrificed needlessly, every one a victim of neglect andincapacity. Between 1200 and 1500 persons had a slow, lingeringillness. A nation of contradictions and paradoxes--a cleanpeople, by whom personal hygiene is carefully cultivated, but ithas displayed in matters of public sanitation a carelessnesssimply criminal: a sensible people, among whom education is morewidely diffused than in any other country, supinely acquiesces inconditions often shameful beyond expression. The solution of theproblem is not very difficult. What has been done elsewhere canbe done here. It is not so much in the cities, though here toothe death rate is still high, but in the smaller towns and ruraldistricts, in many of which the sanitary conditions are stillthose of the Middle Ages. How Galen would have turned up hisnose with contempt at the water supply of the capital of theDominion of Canada, scourged so disgracefully by typhoid fever oflate! There is no question that the public is awakening, but manyState Boards of Health need more efficient organization, andlarger appropriations. Others are models, and it is not for lackof example that many lag behind. The health officers should havespecial training in sanitary science and special courses leadingto diplomas in public health should be given in the medicalschools. Were the health of the people made a question of publicand not of party policy, only a skilled expert could possibly beappointed as a public health officer, not, as is now so often thecase, the man with the political pull.

[7a] Connecticut.

It is a long and tragic story in the annals of this country. Thatdistinguished man, the first professor of physic in thisUniversity in the early years of last century, Dr. Nathan Smith,in that notable monograph on "Typhus Fever" (1824), tells how thedisease had followed him in his various migrations, from 1787,when he began to practice, all through his career, and could hereturn this year, in some hundred and forty or one hundred andfifty families of the state he would find the same miserabletragedy which he had witnessed so often in the same heedlesssacrifice of the young on the altar of ignorance and incapacity.

TUBERCULOSIS

IN a population of about one million, seventeen hundred personsdied of tuberculosis in this state in the year 1911-- a reductionin thirty years of nearly 50 per cent. A generation has changedcompletely our outlook on one of the most terrible scourges ofthe race. It is simply appalling to think of the ravages of thisdisease in civilized communities. Before the discovery by RobertKoch of the bacillus, we were helpless and hopeless; in anOriental fatalism we accepted with folded hands a state ofaffairs which use and wont had made bearable. Today, look at thecontrast! We are both helpful and hopeful. Knowing the cause ofthe disease, knowing how it is distributed, better able torecognize the early symptoms, better able to cure a veryconsiderable portion of all early cases, we have graduallyorganized an enthusiastic campaign which is certain to lead to

victory. The figures I have quoted indicate how progressively themortality is falling. Only, do not let us be disappointed ifthis comparatively rapid fall is not steadily maintained in thecountry at large. It is a long fight against a strong enemy, andat the lowest estimate it will take several generations beforetuberculosis is placed at last, with leprosy and typhus, amongthe vanquished diseases. Education, organization,cooperation--these are the weapons of our warfare. Into detailsI need not enter. The work done by the National Associationunder the strong guidance of its secretary, Mr. Farrand, thepioneer studies of Trudeau and the optimism which he has broughtinto the campaign, the splendid demonstration by the New YorkBoard of Health of what organization can do, have helpedimmensely in this world-wide conflict.

SOME years ago, in an address at Edinburgh, I spoke of the triplegospel which man has published--of his soul, of his goods, of hisbody. This third gospel, the gospel of his body, which brings maninto relation with nature, has been a true evangelion, the gladtidings of the final conquest of nature by which man has redeemedthousands of his fellow men from sickness and from death.

If, in the memorable phrase of the Greek philosopher, Prodicus,"That which benefits human life is God," we may see in this newgospel a link betwixt us and the crowning race of those who eyeto eye shall look on knowledge, and in whose hand nature shall bean open book--an approach to the glorious day of which Shelleysings so gloriously:

HappinessAnd Science dawn though late upon the earth;Peace cheers the mind, health renovates the frame;Disease and pleasure cease to mingle here,Reason and passion cease to combat there,Whilst mind unfettered o'er the earth extendsIts all-subduing energies, and wieldsThe sceptre of a vast dominion there.

(Daemon of the World, Pt. II.)

End of The Project Gutenberg Etext of The Evolution of Modern Medicine

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